CIHM 
Microfiche 
Series 
(l\/lonographs) 


ICMH 

Collection  de 
microfiches 
(monographies) 


111 


Canadian  Inatitut*  for  Historical  Mlcroraproduction*  /  Inttitut  Canadian  da  microraproductions  MMoriquat 


1995 


Technical  and  Bibliographic  Notes  /  Notes  technique  et  bibliographiques 


The  Institute  has  attempted  to  obtain  the  best  original 
copy  available  for  filming.  Features  of  this  copy  which 
may  be  bibliographically  unique,  which  may  alter  any  of 
the  images  in  the  reproduction,  or  which  may 
significantly  change  the  usual  method  of  filming  are 
checked  below. 


D 

D 

D 

D 
0 
D 

D 
D 
D 


D 


Coloured  covers  / 
Couverture  de  couleur 

Covers  damaged  / 
Couverture  endommagee 

Covers  restored  and/or  laminated  / 
Couverture  lesteurte  et/ou  pelliculee 

Cover  title  missing  /  Le  Wre  de  couverture  manque 

Coljured  maps  /  Cartes  gdographiques  en  couleur 

Coloured  inl<  (i.e.  other  ttian  blue  or  [>lack)  / 
Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 

Coloured  plates  and/or  illustrations  / 
Planches  et/ou  illustrations  en  couleur 

Bound  with  other  material  / 
Relid  avec  d'autres  documents 

Only  edition  available  / 
Seule  edition  disponible 

Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin  /  La  reliure  serree  peut 
causer  de  I'ombre  ou  de  la  distorsion  le  long  de 
la  marge  int^rieure. 

Blank  leaves  ^dded  during  restorations  may  appear 
within  the  text.  Whenever  possible,  these  have 
been  omitted  from  filming  /  II  se  peut  que  ceitaines 
pages  blarKhes  ajo'jtees  lors  d'une  restauration 
appaiaissent  dans  le  texte,  mais,  lorsque  cela  etait 
possible,  ces  pages  n'ont  pas  ^  film«es. 


L'Institut  a  microfilm*  le  meilleur  examplaire  qu'il  lui  a 
6t6  possible  de  se  procurer.  Les  details  de  cet  exem- 
plaire  qui  sont  peut-Stre  uniques  du  point  de  vue  bibli- 
ographique,  qui  peuvent  modifier  une  image  reproduiie, 
ou  qui  peuvent  exiger  une  modifications  dans  la  meth- 
ode  normale  de  filmage  sont  indii  iu4s  ci-dessous. 

I     I     Coloured  pages/ Pages  de  couleur 

I     I      Pages  damaged/ Pages  endommagies 

I     I      Pages  restored  and/or  laminated  / 
Pages  restaurees  et/ou  pellicuKes 

[^      Pages  discoloured,  stained  or  foxed  / 
Pages  decolorees,  tachet6es  ou  piqutes 

I     I      Pages  detached/ Pages  dStachSes 

0[      Showthrough  /  Transparence 

I     I      Quality  of  print  varies  / 

— I      Quality  inegale  de  I'impression 

I     I      Includes  supplementary  material  / 

Comptend  du  materiel  suppMmentaire 

r~]  Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc.,  have  been  refilmed  to 
ensure  the  best  possible  image  /  Les  pages 
totalement  ou  paniellement  obscurcies  par  un 
feuillet  d'enata,  une  peljre,  etc.,  ont  6t6  tWtnies 
k  nouveau  de  fafon  k  obtenir  la  meilleure 
image  possible. 

!  I  Opposing  pages  with  varying  colouration  or 
discolourations  are  filmed  twice  to  ensure  the 
best  possible  image  /  Les  pages  s'opposant 
ayant  des  colorations  variables  ou  des  dteol- 
orations  sont  tilmies  deux  fols  afin  d'obtenir  la 
meilleur  image  possible. 


0       ^?^f^""''tl5L.      ■  P«g«"««o  I.  as  f.11o«,  :   p.   [7]  -  MS. 

' — '      CommentaiiBssuppWmentaires:  f    i  j      -wo. 


TItii  item  ii  filnnd  « the  rtduetion  ratio  checked  behm/ 

Ct  dociHiMnt  HI  filmc  au  uux  de  rMuction  indiqut  ci-dtnoin. 


lOX 



14X 

1IX 

22X 

MX 

»x 

u 

/ 

" 

~ 

n 

12X 

16X 

20X 

24  X 

2ax 

^^^ 

^"~^ 

L        1 

J 

UX 


Th*  copy  fllmad  her*  hu  b««n  rsproduead  thanki 
to  th*  gonarotity  of: 

National  Library  of  Canada 


L'axomplaira  film*  fut  raproduit  grtca  i  la 
g*n4roait*  da: 

Blbllotheque  natlonale  du  Canada 


Tha  imagaa  appaaring  hara  ara  tha  baat  qualltv 
poaalbia  conaidaring  tha  condition  and  lagibillty 
of  tha  original  copy  and  in  liaaping  with  tha 
filming  contract  ipocificationa. 


Laa  Imagaa  tuivantaa  ont  ttt  raproduitas  avac  la 
plua  grand  (oin,  eompta  tanu  da  la  condition  at 
da  la  nattata  da  raxamplaira  filml,  at  an 
conformit*  avac  laa  condition*  du  contrat  da 
fllmaga. 


Original  copiaa  in  printad  papar  covara  ara  fllmad 
baginning  with  tlia  front  eovar  and  anding  on 
tha  laat  paga  with  a  printad  or  illuatratad  impraa- 
aion,  or  tha  back  covar  whan  approprlata.  All 
othar  original  copiaa  ara  fllmad  baginning  on  tha 
firat  paga  with  a  printad  or  illuatratad  impraa- 
aion,  and  anding  on  tha  laat  paga  with  a  printad 
or  illuatratad  impraaaion. 


Laa  axamplairaa  originaux  dont  la  couvartura  an 
papiar  aat  imprimta  aont  fiimta  an  commancant 
par  la  pramiar  plat  at  an  tarminant  loil  par  la 
darniira  paga  qui  comporta  una  amprainta 
d'impraaaion  ou  d'illuatration.  soit  par  la  sacond 
plat,  aalon  la  caa.  Toua  laa  autrai  axamplairaa 
originaux  aont  filmaa  an  commangant  par  la 
pramitra  paga  qui  comporta  una  amprainta 
d'impraaaion  ou  d'illuatration  at  an  tarminant  par 
la  darniira  paga  qui  comporta  una  talia 
amprainta. 


Tha  laat  racordad  frama  on  aach  microficha 
ahali  contain  tha  symbol  ^^  (moaning  "CON- 
TINUED"), or  tha  symbol  ▼  (moaning  "END"), 
whiehavar  appliaa. 


Un  daa  symbola*  suivanta  apparaitra  lur  la 
darniira  imaga  da  ehaqua  microficha.  salon  la 
caa:  la  symbola  -^  aignifia  "A  SUIVRE".  la 
aymboia  ▼  aignifia  "FIN". 


Mapa.  plataa.  eharu,  ate,  may  ba  fllmad  at 
diffarant  raduction  ratio*.  Thoaa  too  largo  to  ba 
ontiraly  inciudad  in  ona  axpoaura  ara  fllmad 
baginning  in  tha  uppar  laft  hand  cornar,  laft  to 
right  and  top  to  bottom,  aa  many  framaa  aa 
raquirad.  Tha  following  diagrama  illuatraia  tha 
mathod: 


Laa  cartaa,  planchaa,  tablaaux.  ate.  pauvant  itra 
filmto  i  doa  taux  da  raduction  difftrsnts. 
Loraqua  la  documant  aat  trop  grand  pour  ttra 
raproduit  an  un  saul  clicha.  il  sst  filma  i  partir 
da  I'angia  aupdrlaur  gaucha,  da  gaucha  a  droita. 
at  da  haut  an  baa,  an  pranant  la  nombra 
d'imagaa  nicaaaaira.  l-aa  diagrammas  suivants 
illuatrant  la  mdthoda. 


1  2  3 


1 

2 

3 

4 

5 

6 

Maocorr  •bouition  test  a4A»T 

(ANSI  and  ISO  TEST  CHART  No.  2) 


J     /1PPLIED  IM/GE 


M 


RocHMttf.   Nio   Vofi"         1*609       US* 
(716)   482-  03OO-  Phon. 
(716)   288-5989  -Fa. 


E)^RCISE 

m 

EDUCATION  AND  MEDICINE 


R.  TAIT  McKENZIE.  B.  A.,  M.  D. 

Prnfessor  o(  Physii.il  FduiJiion  an  I  ft 

uiympic    Uilure  (oursc.    St.  L4>uis,    ,004 


mm  346   ILLUSTRATIONS 


PHILADELPHIA  AND  LONDON' 

W.   B.    SAUNDERS    COMPANY 

1909 


- I 


/^^ 


>.>a;7: 


Copyrifht,  1909,  by  W.  B.  Saunden  Companj 


MINTID   IN   AHCflIC* 

PRESD  or 

m.   ■.   lAUNOERS  COMFANY 
VHIUDILPMI* 


"  Man  i!  the  sum  of  his  movenicnw."_F.  H.  Robertson 

pns.7^:;stt!;^=T^^-:;:-"-"--.«on,. 

lo  .It  'M"  ■'  "•"''''""'  ""'■  """"^  '""JHtaes  may  require  exerrisc  in  „,der 

W.H,  .im.e.  .He .™.  .r^j^,TXT-::;:r :j:^  -  - 


PREFACE 


..v.J"''  !""?"■'""  ''"''"  "'  addrcssi.rl  to  students  and  nracti 

dents  of  mcdicmc  and  to  i,s  practitioners,  with  the  p  r,K,se  to 
give  a  comprehcns  vf  vieu-  nf  .i,„  .  p-'"p"»-  lo 

"1/ ,  r?;L"Tt'';  *• "~" ,-'  """-■""■ 

"Housn^s  Bith  which  ih^  vvh^i     T.      ?  "'"""  ="P«'- 


The  proKTi'ss  of  mcilial  i<citnci'  has  Ix'cn  most  notable  in  the 
Kriat  iiui'slions  of  national  heullli  and  |)rr».|Krity  involval  in  the 
fuelling,  housin);,  and  ixcniM'  of  ihi'  pwipli'.  School  Ixuinb  are 
n|>|x'alinK  for  midical  ins|H'ition  of  the  children  lo  discover  cor- 
rectable defects  and  to  prevent  the  spread  of  ilisease.  The 
pern  cious  influence  of  indoor  life  on  growth  has  been  proved, 
and  measures  are  now  taken  to  remedy  it  by  exercise  ami  play; 
city  slums  are  replaced  liy  play^roun-ls,  cc.MeKes  and  universities 
are  placing  on  their  cuniculum  instruction  in  physical  education, 
l)oth  practical  and  theoreiical,  since  the  necesshy  tor  exact  know- 
ledge of  the  physical  charecteristics  which  dilTerenliate  the  child 
from  the  youth,  and  Imlh  from  the  adult,  has  become  patent  to 
the  thoughtful  physician  whose  advice  is  so  constantly  iisked. 

Exercise  and  nassage  have  been  used  as  remedial  agencies 
since  the  days  of  .-Esculapius,  but  delinile  instruction  in  their  use 
has  seldom  been  given  to  mwlical  students.  Perhaps  a  certain 
laziness  which  is  inherent  in  Imlh  |iatient  and  physician  tempts  to 
the  administration  of  a  pill  or  draught  to  purge  the  sy  tem  of  what 
should  be  us«l  in  normal  muscular  activity,  but  there  is  a  wide 
dearth  of  knowledge  among  the  profession  of  the  sco|x;  and 
application  of  exercise  in  jMit-hologic  conditions,  and  the  neces- 
sity of  care  in  the  choice  and  accuracy  of  the  dosage  will  be 
emphasized  throughout  the  second  part  of  this  lx»k. 

1  have  endeavereil  to  acknowledge  in  the  text  the  sources 
from  which  facts  are  culled,  but  I  must  especially  acknowledge 
my  indcbtctlness  to  the  inspiring  friendship  of  my  colleague, 
Dudley  A.  Sargent,  to  E.  M.  Hartwell,  from  whose  classic  re- 
jiorts  to  the  U.  S.  Bureau  of  Education,  much  of  the  historical 
data  relating  to  gymnastic  systems  was  obtained;  also  to 
Fred.  E.  Leonard,  of  Oberlin,  whose  historical  researches  on 
physical  wlucation  hav,  been  mined  with  rich  results.  The 
studies  of  Luther  Halse;  Gulick,  on  the  development  of  plays 
among  children,  and  G.  Stanley  Hall's  work  on  Adolescence 
have  been  most  serviceable  sources  of  inspiration,  while  the  chap- 
ters on  exercise  for  the  blind,  deaf,  anil  mental  defectives  have 
been    founded   on    the    work   of   Edward  Allen,  Grace  Green, 


MEFACE 


».1 


an.1  Mauncc  Barr,  in  .heir  n,,«,ive  sptxial.ic.  In  .he  section 
on  m„hc.  ,r.a,mc.„,  I  hav.  striven  .o  crali,  o.hcr  w^rk  ■  in 
he  ncUwuh.h..  contributions  , hey  have  ma.le,  bu.  mu.h  of  " 
.»  my  o«n  ex,«rience,  Kather.,!  from  a  s,x.cial  praciee  in  h " 
application  of  exercise.  '  "" 

.his'clnderell!'  TX'^u   ""■■  ''.^■'"  '"  P'""'  '''''"-  "'^'  l-f'-ion 
Cinderella  ..f  the  therapeutic  family  in  her  true  character. 


PHii..\i»Ki,i'Hr\.  Pa. 


K.  T.  M. 


CONTENTS 

PART  I 

EXERCISE  IN  EbUCATION 

T„. M  CHAPTER    I 

The  Ukhnition  and  Class.kkat.u.v  of  Kxehcses ™^ 

T„     o  t-HAPTKR    II 

lat  PaysioLoov  of  Kxkriisk 

") 

.,  CIIAPTIIR    III 

MASSAOE   AND   PaSSI\  E    MoTIONS 

-IS 

CHAPTKR    IV 

tXERCISE    BY   Al'PABATUS 

56 

T,       ,.  CHAI'TKR    V 

The  German  System  of  Physicai.  Traimn, 

74 

~       ,.  CHAPTF.R    VI 

The  Swedish  System  of  (;ymnastics 

«0 

T„r  ..t         „  CHAPTKR    VII 

r^^n^:::^'..r'c>;^-';,;^r:  ••<-»-  -  Keeanat,on,..  and 

104 

.^   „  CHAPTKR    VIII 

AGE,  Sen,  and  Occupation 

122 

p,„  CHAPTKR    IX 

Playgrounds  and  Municifai,  (;ymnasiums 

'37 

„  CHAPTKR    X 

i-HvsicAL  Education  in  Scaoois 

"58 

„„,  „  CHAPTKR   XI 

I  HVSICAt    EDUCATION   IN   THE   Co,.,.F,:E   AND    l-NIVEHSITY ,  ^^ 

T.,     „  CHAPTKR    XII 

The  physicai.  Education  of  the  Bund  and  the  Deaf-mute ,„ 

CHAPTER   XIII 
PavsicAi,  Education  of  Meniae  and  Moral  Defectives .,,.„„ 

>5 


l6  CONTENTS 

PART  11 

EXERCISE  IN  MEDICINE 

CHAPTKR    XIV  „^^ 

The  Application  op  Exekcise  to  Patholooic  Conditions 213 

CHAPTER  XV 

Flat-foot  and  its  Theatment ^.g 

CHAPTKR    XVI 

The  Cause  and  Treatment  of  Round  Back,  Stooped  and  Uneven 

Shoulders 

'SO 

CHAPTER    XVH 

Scoliosis— Its  Causes,  Varieties,  Diagnosis,  and  Prognosis 27, 

CHAPTER   XVIII 

The  Treatment  of  Scoliosis 

CHAPTER   XIX 
Exercise  and  Athletics  as  a  Factor  in  Diseases  op  the  Circulation.  ,,,5 

CHAPTER    XX 

The  Exercise  Treatment  of  Diseases  op  the  Circulation 335 

CHAPTER    XXI 

Obesity— Its  Causes  and  Treatment ,.5 

CHAPTER   XXII 

Other  Disorders  of  Nutrition ,,g 

CHAPTER   XXIII 

Exercise  in  the  Treatment  of  Nervous  Diseases 370 

CHAPTER  XXIV 

The  Treatment  op  Locomotor  Ataxia  by  Exercise 383 

INDEX  

.W5 


EXERCISE  IN   EDUCATION  AND  MEDICINE 


PARTI 

EXERCISE  IN   EDUCATION 


CHAPTER    I 


THE  DEFINITION  AND  CLASSIFICATION  OF 
EXERCISES 

The  term  exercise,  as  here  employed,  comprises  all  movements, 
voluntary  or  pass.ve,  including  manipulations  bv  the  hand  of  ar^ 

ZT7   '  "  """"''  '"'■«"^'' '"  ""  °"  '^"^  "-'-•  'he  Mo,^ 
"'!!'*:  'he  nervous  system,  the  skin,  and  the  abdominal  orj-an,. 

and^tfeffi     "'"      '"'T^"  "  ""'-^"^^  '"  ~™^  ''^  "Pl-'i-'ion 
and  Its  efficacy  as  a  medicinal  agent. 

It  naturally  falls  into  the  t™  main  divisions  given  bv  Plato- 
active  and  passive.  ■      """^ 

I.  Active  exercise  requires  a  defmite  exertion  of  the  will 
power,  whether  in  its  more  complicated  form  of  games  and  gvm- 
nasucs,  or  ,n  s.mple  duplicate  directed  movements  with  assistance 
or  resistance  by  tha  hands  of  an  operator  or  by  a  machine 

ooJp'r  T.™  ™'"'''  ''°''  ""'  '"1"'^^  ^"y  ^^^'o"  of  "ill 
po«er.     The  v-ar,ous  manipulations  of  massage,  bv  means  of  the 

ttctT  '  """''■""  "'  ^^"^"  ""^  ''"'"^'  by«hich  con- 
tracted hgaments  or  muscles  are  stretched  and  nourished,  local 
nuwion  improved  nerves  stimulated,  and  the  abdominal  organs 
aff^ted,  are  restful  rather  than  exhausting  to  an  overwrought 

.  st^rrr'^  """■  ^"  "-'^'"''"^"^  '"'°'  ''^^''  'h°^e  involving 
a  smgle  ./«,/  of  one  or  more  muscle  groups,  such  as  lifting  a 
weight  or  performing  a  feat  on  the  parallel  bars;  and.  second 

3  * 


i8 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


exercises  of  endurance,  consisting  of  motions  rhythmically  repeated 
without  great  muscular  expenditure  for  each  one,  and  depending 
for  their  effect  upon  continuous  repetition. 

Exerciser  of  effort  may  be  more  or  less  violent  in  character  or 
compound  in  motion,  each  one  starting  from  and  ending  with  rest. 
They  are  in  endless  variety,  from  simple  movements  of  lifting  and 
throwing,  to  the  complicated  combinations  on  the  parallel  bars 
and  horizontal  bar.  In  them  the  element  of  skill  plays  a  leading 
r6le,  and  what  would  be  .  mild  exercise  for  the  expert  may  be  a 
severe  strain  to  the  beginner,  whose  inaccuracy  means  the  clumsy 
employment  of  many  muscles  that  help  little  in  its  accomplish- 
ment, the  contraction  of  some  groups  actually  retarding  success. 
Even  in  the  accurate  performance  of  an  apparently  simple  move- 
ment, the  distribution  of  muscular  effort  is  wide,  and  increases 
tremendously  with  the  difficulty  of  the  feat.  In  pushing  a  heavy 
dumb-bell  to  arm's  length  above  the  shoulder,  the  extensors  of  the 
elbow-joint  are  the  ones  usually  considered,  but  the  entire  muscular 
system  shares  in  the  effort.  The  grasping  muscles  of  the  hand 
are  required,  also  the  muscles  that  raise  the  shoulder  and 
rotate  the  scapula.  These  are  attached  to  the  spine  and  ribs, 
which  in  turn  must  be  supported  by  the  pelvis,  steadied  on  the 
hips,  while  the  balance  of  the  body  is  preserved  by  the  muscles  of 
the  thigh  and  legs. 

.\  single,  simple  effort,  then,  may  give  rise  to  fatigue  of  more 
than  the  muscles  most  obviously  employed. 

Education  should  be  directed  to  teaching  skill  in  the  per- 
formance of  such  movements— skill  that  tends  to  economize  the 
amount  of  effort  required — for  it  is  the  common  experience  of  shot- 
putters  to  find  that  their  record  performance  is  accomplished 
with  the  greatest  ease,  owing  to  the  smooth,  accurate  applica.  ,n 
of  group  after  group  of  muscles  at  the  ])roper  time;  and  the  perfec- 
tion of  balance  and  speed  of  the  body's  movement. 

However  skilful  the  performer  may  be,  the  whole  muscular 
system  participates  in  any  violent  exercise  of  effort.  During 
the  intense  concentration  so  necessary  for  success,  the  chest-walls 
are  fixed ;  the  glottis  is  closed,  the  lungs  acting  as  an  air  cushion 


THE   DKFIXITIO.V   ANI,  CLASSIFICATION   OF   EXERCISES         ,9 

there  IS  an  explosne  discharge  of  nervous  energy,  the  intensity 
of^^«h,ch   .s_ni,rrored   in  the  muscular  rigidit/ of  the  atw":^ 


S:ed^^vrr^ra:;'S;;^tj- 

no?-  .  '"''  "PP"  ''P  '"'™  »  ^''^''■ng  expression    the 


ao  EXBRCISE   IN   EDUCATION   AND   MEDICI  SE 

.ands  out  along  the  neck  like  cord,    ^he  general  impre.^^^^^^^ 
ih,.  face  is  repulsive  and  corresponds  closely  to  the  face  oi  ra« 

exposed,  presenting  the  appearance  of  one  m  readiness 
o'  seizing  the  enemy. 


f^!r^!^„  „,  „Tor,  ,e.n  in  .hrowi„«  the  hammer^ 


in  his  drawing  of  ra,.  Sir  Charles  Be.P  sho..  a  face  corre- 

heart  -""^  '^^''f „^  ,  ",To  L  po-t  of  seriously  endangering 
drives  up  the  blo<xl-pe  sure  o        P        ^.^^^^,i„„_  ^^e  hammer- 

the  dehcate  vessels  of  the  eye  If"'"  he  could.    Indeed,  the 

,.ower  or  the  ^l'^'"- -"^^rhs  eye"     the  mlent  of  greatest 

S-r :lf  "Srn.k,  the  platys..  springs 

. ..  Kxprcssion  ,>f  .he  Emolion,  in  Man  an.l  Animals.  ' 
'  "  Expression  of  the  Emotions.' 


THE  DEFINITION   AND  CLASSIFICATION   OF   EXERCISES  21 

into  action  wherever  violent  effort  is  performe.1,  as  in  deliverinL- 
a  blow,  and  sometimes  even  in  testing  the  grip  by  the  clymimo. 
moter.     It  is  the  muscle  of  emphasis. 

Gam..s  and  feats  of  speed,  in  which  many  movements  must  be 
repeate,.  as  .juickly  as  possible  in  a  certain  limited  time,  may  well 
be  classed  as  exercises  of  effort,  since  practically  all  the  conditions 
of  a  single  effort  apfily  to  them. 

In  a  loo-yard  dash,  occupying  about  ten  seconds,  the  con- 
centration of  attention  is  continued  at  its  highest  ,x.int  throughout. 
The  breath  is  held,  and  the  whole  muscular  system  is  convulsed 
with  supreme  effort,  while  the  bloo,l-pressurc  rises,  much  as 
It  does  in  the  single  effort  of  throwing  the  hammer  or  putting  the 
shot.  If,  however,  the  rate  be  reduced  and  the  runner  be  allowe.l 
twenty  seconds  or  more  to  cover  the  loo  yards,  the  nervous 
tension  disappears;  the  blood-pressure  is  but  little  affected-  there 
IS  no  nervous  explosion,  and  the  face  remains  calm  and  smiling. 
J  he  same  exercise  becomes,  under  these  con<litions,  one  of 
mUd  endurance;  and  the  possibility  of  this  transition  in  the  same 
exercise  from  effort  to  endurance,  or  from  endurance  to  effort 
must  be  constantly  borne  in  mind,  much  confusion  having  occurred 
by  the  careless  use  of  these  terms. 

Feats  of  skill,  such  as  juggling,  are  composed  of  isolated  efforts 
which  may  be  so  mild  in  nature  and  so  often  repeated  that  they 
msensibly  shade  off  into  feats  of  endurance,  especially  when  skill 
and  practice  render  them  automatic.  The  striking  of  a  fortissimo 
chord  on  the  piano  is  an  exercise  of  effort.  The  practice  of  one 
scale  for  an  hour  would  be  an  exercise  of  endurance,  but  the  plav- 
mg  of  the  thirteenth  rhapsody  of  Liszt,  combines  both  effort  and 
endurance. 

The  qualities  cultivaterl  by  exercises  of  effort,  whether  of 
strength,  skill,  or  spee<l,  include  mental  concentration;  the  rapid 
response  of  the  muscle  to  the  will  power;  the  ability  to  learn  com- 
plicated coordinations  and  the  knowledge  of  the  easiest  and  most 
economic  way  of  performing  difficult  movements.  Their  prac 
tice  IS  followed  by  increase  in  the  size  of  the  muscles  employed  up 
to  their  physiologic  limit.    If  carried  past  the  limit  of  power  the 


31  EXERCISE   IN    EDICATIOS   AND   MEDICINE 

musclfs  will  refuse  to  contract,  or  may  actually  tear,  and  if  habitu- 
ally overworke.1,  thev  may  atrophy,  and  l)ccome  hard  and  fibrous 
with  weak,  uncertain  movements.  When  muscles  are  over- 
develo,)ed,they  become  parasites  on  the  vitality,  which  is  sapped 
in  the  struggle  to  provide  for  their  nourishment.  Exercises  of 
effort  do  not  cultivate  constitutional  vigor  to  the  same  extent  as 
those  of  endurance. 

In  exercises  of  endurance  the  range  and  variety  of  movement 
are  usually  much  more  lin-.itcl.  They  are  confmed  to  a  few- 
well-known  varieties,  such  as  walking,  running,  and  rowing,  and 
though  each  movement  is  well  within  one's  power,  the  total 
amount  of  muscular  work  is  great,  but  as  the  contraction  and 
relaxation  is  comijarativcly  slow,  the  poisonous  waste  matter  pro- 
ducing fatigue  is  removed  from  the  muscles  as  it  accumulates.  Jn 
exercises  of  effort  there  is  no  time  for  the  scavengers  to  work, 
fatigue  of  the  most  active  muscles  setting  in  rapidly,  while  in 
exercises  of  endurance  they  can,  at  least,  postpone  its  onset. 

This  class  is,  then,  milder  and  more  general  in  character. 
It  deals  with  coordinations  familar  from  infancy.  It  is  not  neces- 
sary to  concentrate  the  attention  on  every  movement  in  walking, 
running,  and  rowing,-typical  exercises  of  endurance— in  them  the 
mind  may  be  occupie.1  with  other  thoughts.  Breathing,  which  is  a 
muscular  action  of  endurance,  is  entirely  automatic,  but  is  not 
subject  to  the  ordinary  laws  of  fatigue. 

The  qualities  cuhivated  bv  exercises  of  endurance  are  different 
from  those  required  in  effort.  Skill  is  not  prominent  among  them. 
Concentration  is  replaced  by  the  attempt  to  liberate  the  attention, 
and  the  development  of  any  one  group  of  muscles  is  secondary  to 
th.  indirect  effect  on  the  circulation  and  respiration  in  training 
them  to  remove  the  fatigue  products  of  muscular  contraction. 

When  carried  to  excess,  exercises  of  endurance  are  accompanied 
by  acute  constitutional  exhaustion,  shown  in  breathlessness,  from 
which  recovery  is  rapid;  by  fatigue  of  the  whole  muscular  system, 
from  which  a  rest  of  a  day  or  two  is  necessary,  and  by  the  chronic 
or  nerve  fatigue  known  as  "  staleness"  among  trainers,  from  which 
recovery  may  be  a  matter  of  weeks  or  even  months. 


THE   DEmiTION   A.VD  CLASSIFICATION   OF   EXERCISES         33 

Fatigue  apfwars  in  one  of  ijii-sc  three  xvays. 
H  the  exercise  be  sufficiently   active,    the    amount  of   waste 
mutenal  sud.lenly  thrown  into  the  circulation   is  Rreater   than 
can  be  ehmmated  by  the  lungs.     The  breathing  becomes  rapid 
and     shallow,     the    pulse 
quick    and    fluttering,  and 
the  runner  feels  a  sense  of 
constriction     around     the 
chest;  his  head  swims  and 
throbs   and   his  face  takes 
on  the  anxious  expression 
so  clo(|uently  telling  of  the 
thirst  for  air. 

The  face  of  the  breath- 
less man  is  unmistakable. 
The  smoothness  of  the  fore- 
head is  broken  by  wrinkles 
spreading  out  over  the  inner 
end  of  the  updrawn  eye- 
brows. The  general  direc- 
tion of  the  eyebrows  is  just 
the  reverse  of  that  seen  in 
violent  effort.  They  are 
drawn  upward  and  inward 
by  what  the  French  call 
"the  muscle  of  pain," 
whose  action  is  seen  in  the 

expression  of  grief,  mental  fir.  j.-rhc  lypici  f.cc  „f  b™ihi«„„e.« . 
distress,  anxiety,  or  bodily   ^"  '"  ""^  ""  "*""'  '"•  yrfs  (modeica 

■  „;„  TU  ,•  ,      .        '"""  li'"^  by  the  author). 

pam.      The  upper  lids  m 

breathlessness  droop  and  half  cover  the  eyeball,  giving  a  look  of 
great  lassitude  to  the  suffering  expressed  by  this  region.  The 
nostrils  are  widely  dilated,  and  the  mouth  gapes,  with  lips  retracted 
m  the  mad  struggle  for  air.  The  raised  upper  lip  adds  to  the  look 
of  sorrow  and  pain,  while  the  down-drawn  mouth  angle,  the  tongue 
closely  pressed  against  the  teeth,  the  sunken  cheek,  and  the  open 


24  EXE«CI»E  IN  EDfCATION  AND  MEDICINE 

mouth,  all  go  to  increase  the  exhausted,  haggard  look  so  character- 
Istic  of  this  state,  in  distinction  to  mere  Ijodily  pain  c  mental 
suffering.  The  general  i>oisc  of  the  head  is  backward,  the  chin 
thrust  forward,  and  the  neck  strained  or  convulsed. 

With  the  refeitablishment  of  e(|uilibrium  lictween  the  produc- 
tion of  waste  and  its  elimination,  the  urgency  of  breathlessness 
fades  and  the  runner  gets  what  is  called  his  "second  wind."  The 
look  of  distress  disap|wars  from  his  face.  The  lungs  regain  fresh 
power  to  expand,  the  head  becomes  clear,  ,ind  the  muscles  act  with 
renewed  vigor  and  elasticity. 

He  can  now  continue  running  until  he  feels  the  symi>toms  of 
general  fatigue. 

If  the  pace  has  been  slow  enough,  the  runner  may  escape  the 
acute  |)oisoning  shown  by  breathlessness,  but  sotmer  or  later  the 


Fin.  4.  -The  typiial  cxprMsion  of  breathlcssncM  is  sern  in  llip  last  man. 


products  of  tissue  waste  accumulate,  the  heart  beats  fast  and 
weak,  the  nervous  system  is  stu[)efied,  and  the  muscles  relax. 
This  may,  in  extreme  cases,  end  in  death  from  overcxhaustion,  as 
has  Vjeen  reported  in  soldiers  after  long  and  forced  marches. 

The  same  condition  may  be  studied  in  the  face  of  the  runner 
during  a  long  distance  race.  .After  the  urgency  of  breathlessness 
has  passed,  the  expression  of  his  face  changes.  The  eyebrows 
show  a  slight  frown,  and  the  eyelids  are  heavy,  as  with  sleep;  the 
upi^r  lip  is  still  retracted  from  the  teeth,  giving  a  slight  look  of 
pain  to  the  cheek,  otherwise  relaxed  and  flaccid.  The  mouth  is 
half  open,  the  jaw  drops,  and  the  lower  lip  hangs  loosely  over  the 
parted  teeth.  The  general  expression  is  one  of  vacancy.  As  fatigue 
becomes  more  profound,  his  effort  is  centered  in  an  endeavor 
to  prevent   the   eyes  from  closing,  as    a    consequence   of  the 


niE   DKFIN.noN   AND  ClASSIPICATION   OP   tXKRC.SES         JJ 

increasing  paralyHisofthe  rau»clc-»  of  .he-   up,«..r   eydi.U.    The 

S     -^'^.—J    wrinkles    across    .he  leheLi    of    'ms 

"'^'■Iv     tig.    71,   which    shows   advance!    fatigue,    or   the   last 

*age  of  exhaustion,  are  usually  associated  „ith   the  e-.ress^In 

of   surprise   and  astonish-  — 

ment,  but  here  they  illu 

trate  the  cmleavor  to  rais 

the  drooping  eyelid.      The 

nostrils  arc  dilated,  the  lips 

are  drawn   downward  and 

outward,    the    lower    part 

of  the  face  expressing  the 

distress  of  failing  respira 
tion.    The  head  is  thrown 
l)acl;ward    and    the    chin 
thrust  forward  in  the  en 
deavor  to  balance  the  head 
without     muscular    effort, 
Both  pose  and   facial   ex 
jjression   are  characteristic 
of   the  last  effort   to  fight 
off    collapse.      When    this 
last  effort  is  exhausted,  the 
muscles  of  expression  cease 
lo  act,  the  circulation  fails 
the    color    becomes    pale, 
the  lips  livid,  and  the  runner 
falls  in  a  faint. 

The  effec:  of  this  general  fatigue  ,loes  not  usually  pass  away  for 
a  clay  or  two     The  bo<ly  temperature  rises  several  degrees,  the 

disturbed  by  troubled  dreams.  The  urine  passed  is  of  high 
specific  gravity  and  contains  albumin.  The  soreness  and  stiffness 
of  the  muscles  and  joints  remain  for  several  days,  and  gradually 
tade  away  as  the  constitution  recovers  its  tone. 

This  may  be  said  to  represent  the  second  form  of  general 


Fib.  V-Thc  lypical  ,„„  of  fniiju,  ^„  ,„„ 
acute  brealhlessnes.  has  passed  off  in  a  di.lance 
rare  (modeled  from  life  liy  Ihe  aulhor) 


,6  EXERCWK  IN   H.ICATION   ANI.  MtDICINE 

1      ..„      Thf  thiril  or  chronic  (orm  i*  founil  in 
'Z:::;^:^^  .i   >:  l^ich  .H.  an»un. ..  enauran. 

:T  The  ex    uX  tt  .-.naiiy  con.cs  on  i,  ''ow-  b-  more 

Ihc  acute  form,  correc.cl  by  a  (e  v  mmu  -  r^U^  '  ^^^ 

r  r  a::rSy:  .He  n,u..e.  .o.   'Heir^i^  JH..  ^ 

=;trtr;r;r==.::o/or.e 

power  to  louse  himscU  from  liis  letharRy. 


Fi,.  6,-Both  (are.  .how  the  tyr.ic»;  exprr..ion  o(  l.ti«uc. 


Recovery  from  chronic  fatigue,  or  <rvcr,raining,\^  a  matter  of 

^       n7  .ince  the  nervous  system  is  profoundly  affected,  a 

ri  :ft: Tu"ou:.iings,  and  ^cupation,  with  complete  muscu- 

'-'  ;n;  ::LM<I^r:^e  amon,  trainers  to  give  .on,  d.t^ 
.unne;:  I  rest  of  two  or  three  days  before  a  race  to  recover  com- 

„auran^ce,b.iusta..^-^^^^^^ 

become  one  of  endurance    so       8  ^„„^,    i^y, 

sufficiently  in  its  pace  to  mal<e  ,t  an  exerc.se 
a  more  important  P  .rt  than  -''-"«^;- ^^^^^ fo  muscular 
will  carefully  regulate  his  pace  so  that  the  waste  mane 


THK   nKFINITION   AXri  CLASHtFtCATroN   DF    KXEHCISKS  j; 

contraction  can  Iw  climinatnl  almost  a*  (|uickly  as  it  i>  prixluiid. 
anil  his  rfsourci's  husliunilcd  for  the  moment  when  cx|KTicme 
teachc!!  him  he  can  exert  all  hin  latent  iwwer  in  the  Cmal  spurt. 
This  is  so  timed  that  the  finish  line  will  find  him  completely  breath- 
less anil  exhausteil. 

A    mile  race    is.    then,  I 
an  exercise    of    endurance 
th^ou^hout  most  of  the  ilis-  | 
tance.  and  at  the  finish 
exercise     of     cflort.      the  I 
change  showing  by  the  ex- 
pression r)f  the  face.     It  is 
in  'mdinj;  out  the  pace  and  I 
tlie  ]K)int  at   which   effort 
must  be(?in  that  the  genius 
of  the  true  athlete  is  set 
or  the  skill  of  the  trainer  i; 
shown. 

Exercises  of  endurance,  I 
then,  have  much  more  pro- 
found influence  on  the  Ren- 
eral  system  than  exercises  | 
of  effort. 

In  the  typical  exercises  I 
of  effort,  such  as  feats  of  | 
stretigth  or  skill,  the  result- 
ing fatigue  is  principally  a  ' 
local    one,    and     includes 
soreness    of    the    muscle 
most  strongly  in  action,  which  refuse  to  function  when  the  effort 
becomes  too  great. 

In  exercises  of  endurance  the  constitutional  fatigue  is  greater 
and  powerfully  affects  the  heart,  lungs,  general  muscular  and  ner- 
vous systems. 

Passive  exercise  finds  its  widest  field  of  usefulness  in  conditions 
of  fatigue,  where  the  elimination  of  waste  matter  must  be  assisted, 


Fir.  7.— The  typical  f.itc  of  cxhaustio 
jusl  Man  collapse  in  a  litslailrt-  race  (mixlektl 
from  life  l>)  the  author). 


28  EXERCISE  IN   EDUCATION  AND  MEDICINE 

and  where  nutrition  of  the  part  is  impaired  or  destroyed.  The 
patient  remains  inert  and  is  acted  upon  by  the  operator  or  his, 
mechanical  substitute.  Muscles  can  be  improved  in  size,  tone, 
and  nutrition,  ligaments  stretched  and  strengthened,  the  general 
circulation  quickened,  and  overloaded  veins    made  to  disgorge 


Fig.  8.— The  finish  of  a  r 


',  showing  effort  on  the  right,  exhaustion  in  the  center,  and 
collapse  on  the  left. 


their  blood.  The  digestive  tract  can  be  stimulated  to  more 
active  habits,  and  overwrought  nerves  soothed  and  relieved  of 
their   hypersensibility. 

The  full  and  detailed  description  of  the  typical  movements  of 
massage  will,  however,  require  a  chapter  to  itself. 


CHAPTER    II 
THE  PHYSIOLCXJY  OF  EXERCISE 

Bodily  movements  affect  ])rofoundIy  the  motor  apparatus. 
the  vessels  which  supply  it  with  nourishment  in  the  form  of  I)loo<l 
and  lymph,  the  storehouses  of  nutrition  in  the  abdomen,  and  the 
controlling  and  directing  mechanism  of  brain  and  nerve. 

The  impulse  to  contract  a  muscle  begins  at  its  motor  center 
in  the  brain  or  spinal  cord,  and  is  carried  to  it  by  a  motor  nerve. 
Each  muscle-cell  shortens  and  thickens,  scattering  some  of  its  sub- 
stance into  the  lymph-space  encircling  it,  and  absorbing  food  con- 
sisting of  carbohydrates  and  oxygen  from  this  surrounding  jilasma. 

By  repeated  contraction  the  cells  increase  in  size  and  number, 
the  perimysium  is  strengthened,  the  fibrous  wall  surrounding  the 
bundle  of  cells  is  invigorated,  and  fresh  power  is  imparted  to  the 
sheath  inclosing  the  entire  muscle.  The  result  is  an  increase  in 
bulk,  in  strength,  and  in  elasticity.  The  tone  of  a  healthy  muscle 
keeps  it  in  slight  contraction  even  when  at  rest,  so  that  antago- 
nistic groups  retain  the  inactive  limb  in  normal  position,  but  con- 
stant overaction  and  strengthening  of  one  grouj)  of  muscles  increases 
this  normal  tension  until  the  accustomed  pose  becomes  habitual,  as 
in  the  curved  fmgers  or  bent  arms  of  the  oarsman  or  weight- 
lifter.  '^ 

During  contraction  there  may  be  actual  rupture  of  the  cell- 
walls  and  exudation  of  blotxl  and  lymph.  This  is  one  of  the  two 
causes  of  muscle  soreness  found  after  severe  straining  exercise. 
The  other  cause  is  the  presence  of  irritating  waste  matter  imper- 
fectly carried  off  by  the  blood-stream.  This  ])rocess  of  elimination 
is  improved  if  the  muscle  be  kept  warm,  but  as  muscular  action 
generates  heat,  this  usually  regulates  itself.  When  the  limb  is  cold 
or  inactive,  the  heat  of  the  muscles  must  be  enkindled  by  prelimi- 
nary massage  and  light  exercise  before  undertaking  with  safety  anv 


3° 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


severe  athletic  test.  The  lack  of  this  precaution  in  cold  vveather 
is  the  cause  of  most  ruptured  muscles  and  tendon  strains.  Galen^ 
recognized  this  fact  in  the  second  century  and  writes:  "If  any  one 
immediately  after  undressing  proceed  to  the  more  violent  move- 
ments before  he  has  softened  the  whole  body  and  thinned  the 
excretions  and  opened  the  jjores,  he  incurs  the  danger  of  breaking 
or  spraining  some  of  the  solid  parts,  .  .  .  but  if  beforehand  you 
gradually  warm  and  soften  the  solids  and  thin  the  fluids,  and 
expand  the  pores,  the  jxTson  exercising  will  n;ii  no  danger  of 
breaking  any  part." 

The  overpro<luction  of  heat  is  fairly  well  equalized  by  evap- 
oration through  the  skin  and  lungs,  although  general  massage  is 
followed  by  a  slight  rise  in  temperature,  and  there  is  always 
some  fever  attending  and  following  a  long  distance  race. 

The  effects  of  the  three  kinds  of  exercise  described  in  the 
previous  chapter  on  the  structure  and  behavior  of  the  muscle  vary 
widely.  Single  and  complete  contraction,  however  mild  the 
resistance,  improves  the  nutrition  if  frequently  repeated,  as  shown 
by  an  increase  in  size  and  efficiency.  When,  however,  the  tension 
is  habitually  excessive,  minute  ruptures  occur  in  its  substance  and 
sheath,  fibrous  deposits  are  formed,  and  the  muscle  itself  becomes 
shortened,  hard,  and  inelastic.  Even  when  at  rest,  the  specialist  on 
the  horizontal  bar  will  show  the  rounded  shoulders,  the  bent  arms, 
and  curved  fingers  developed  by  too  exclusive  devotion  to  this 
exercise. 

The  number  of  muscles  involved  in  a  simple  movement  multi- 
plies with  the  intensity  of  the  effort.  The  trial  of  grasping  power 
by  the  hand  dynamometer  is  designed  to  test  the  flexors  of  the 
hand  and  forearm,  but  in  the  strife  for  additional  force,  muscular 
contraction  spreads  to  the  arm  and  shoulder  and  throughout  the 
entire  muscular  system  until  its  intensity  is  expressed  by  the  face. 
If,  however,  skill  is  an  important  factor  in  the  exercise,  the  em- 
|)hasis  on  alacrity  and  accurate  control  cultivates  in  the  muscle 
economy  of  effort  and  promptness  in  responding  to  the  will. 
In  other  words,  the  latent  [)eriod  is  shortened. 

In  exercises  of  endurance  each  movement  is  comparatively 


THE  PHYSIOLOGY  OF  EXERCISE  „ 

mild,  and  there  is  less  tendency  to  shortening  and  stiffening  of 
the  muscle  so  frequently  found  after  extreme  effort.  Develop 
ment  ,s  general  rather  than  local,  and  long  distance  runners  are 
not  noted  for  the  thickness  of  their  calves. 

General  nutrition  is  best  improved  by  the  rhythmic  self-massage 
of  movement.  "  Every  muscle  is  a  throbbing  heart,  squeezing  it4 
vessels  empty  «hile  in  motion  and  relaxing  to  allow  them  to  fill  u„ 
anew  (Weir  Mitchell).  The  element  of  skill  does  not  play  an 
important  part  ,  such  habitual  or  automatic  movements  as  walk- 
ing or  running,  so  that  their  value  in  its  promotion  is  compara- 
tively slight.  ' 

Passive  exercise  improves  the  nourishment  of  the  muscle-cell 
by  forcmg  out  the  products  of  fatigue  and  keeping  it  bathe,l  in  a 
constantly  renewed  stream  of  arterial  bloo<l.  This  alone  is  suffi- 
cient to  prevent  wasting  of  substance  in  conditions  where  active 
movements  arc  impossible,  but  it  has  little  power  to  modify 
muscular  strength  or  control. 

It  can  be  demonstrated  that  the  amount  of  blood  in  the 
muse  e,  as  in  the  heart,  varies  with  its  contraction  and  relaxation 
Mosso,  of  Turin,  found  that  an  arm  inclosed  in  a  water  plethys 
mograph  (Fig.  9)  diminished  in  volume  on  contracting  the  flexors 
aiid  .mmediately  increased  above  its  ori,,;inal  volume  when  they  were 
relaxed.  He  also  found  an  increase  in  the  amplitude  of  the  pulsations 
of  the  whole  arm  during  and  after  the  contraction  of  the  flexors 
These  experiments  have  been  confirmed  by  Sir  Lauder  Brunton 
and  other  observers,  and  it  may  be  considered  as  conclusively 
proved  that  the  blood-vessels  are  substantially  enlarged  in  the 
active  muscle  after  contraction,  and  during  the  contraction  itself 
the  interchange  of  products  between  blood  and  muscle  is  also 
accelerated  Not  only  is  this  true,  but  the  actual  nourishing  power 
of  the  blood  is  augmented  by  this  heightened  activity 

It  has  been  proved  by  Hawk,  in  his  interesting  experiments  on 
the  blood-count  of  athletes  in  training-  at  the  University  of  Penn- 
sylvania, that  various  forms  of  active  muscular  exercise  produce 
an  average  increase  of  16.S  per  cent,  in  the  number  of  red  corpus- 

^  "  Am.  Journal  nf  Phv-sioi„g^/'  vul.  x.   X.i.  viii 


3' 


EXEtCISE   IN   ED'        nON   AND  MEDICINE 


clcs,  the  greatest  increase  being  26.7  per  cent,  in  a  subject  who  had 
played  water  polo  for  a  period  of  three  minutes,  the  lowest  increase 
being  noticed  after  long  runs  and  bicycling.  Whei  exercise  is 
long  continued,  the  rate  of  increase  lessens  and  the  number  may 
even  decrease  in  violent  exercise  sufficiently  prolonged.  Thi^, 
he  explains,  is  due  to  the  passage  into  the  circulating  blood  of  a 
large  number  of  cells  lying  inactive  in  various  parts  of  the  body 
until  they  are  brought  into  service  by  the  muscular  exercise. 


Fig.  , .-A  schematic  dianram  of  Mosjoa  plclhysmograph  (or  the  arms-  „.  Thculass 
cylinder  lor  the  arm,  with  r„bl,r  sleeve  an,I  two  tubulalure,  tor  filling  «-ith  warm  water- 
..the  spiral  spring  swrngine  the  test-tube,  ,■.  The  spring  is  so  calibratol  that  the  level  of 
the  liquid  in  the  test-tube  alxive  the  arm  remains  unchanged  a.  the  tube  is  filled  and 
emptied.  The  movements  of  the  tube  are  recorded  on  a  drum  by  the  w-ting  point,  /,. 
(Howell).  ' 

John  K.  Mitchell  gives  the  same  explanation'  for  a  similar 
increase  found  after  massage.  This  would  also  account  for  the 
fact  that  they  decrease  after  prolonged  exercise  in  which  this 
reserve,  as  well  as  the  original  circulating  proportion,  is  con- 
sumed in  the  furnace  of  musculai  action.  The  specific  gra\ity 
of  the  blood  is  heightened  by  evaporation  from  the  lungs  and  this 
tends  to  mask  the  continual  destiuction  of  red  ceils  in  long  tests  of 

.\m.  Journal  of  Medical  Sciences,"  1894,  cvii. 


THE  PHYSIOLOGY  OF  EXERCISE 

""rt;:;i:j:7  ""'-.°^  ""-'"'^  ---« the  wood . 

to  replace  et^^      1'^  'TT  ""'  T""'  "'  '"''  '"«-*^'' 
the  blood  are^L  velv  in  T^    ""  •"^«'="  ^"^"'"^    ■'" 

destroy  tissue  wis  ™'  '""''''^"''  '^  "'  ">«  -^ite  cells  that 

,  arteries  with  a  more  powerful  sfrnkp      Ti,„ 

An  additional  amount  of  m   ^on  k„    i-    • 
power  of  elimination  can  th-s  be  acauir^H  ,  ^^  .^"""^^«' 


» 


EXERCISE   IN    EDICATION   AND  MEDICINE 


ears,  dizziness,  and  a  feeling  of  suffocation,  wliile  accompanying 
the  thirst  for  air  is  mental  anitiety,  confusion,  and  even  uncon- 
sciousness. The  facial  expression  of  the  breathless  man  has  been 
already  described. 

This  physical  distress  is  preceded  by  a  period  of  stimulation 
in  which  the  eye  becomes  bright,  the  skin  flushed,  and  a  warm 
glow  is  felt  from  the  dilatation  of  the  capillaries.  This  dilatation 
of  the  capillaries  is  a  sign  of  the  increased  power  of  the  heart-beat, 


Fig.  lo.— Stanton's  sphygmomanometer;  i,  Leather  cuff  in  place  on  the  arm;  a. 
bulb  grasped  in  hand  tor  pumping  air  into  the  tube  under  the  cuff  to  obliterate  the 
pulse  ;  3,  glass  tube  graduated  to  show  the  height  of  the  column  of  mercurj'  required 
(Da  Costa). 

which  exalts  the  tension  throughout  the  whole  arterial  system  and 
drives  the  blood  with  quickened  stream  through  vessels  which  at 
rest  are  almost  empty. 

Blood-pressure  is  also  raised  by  any  obstruction  of  its  return 
to  the  right  side  of  the  heart.  The  causes  of  raising  or  lowering 
it  will  be  considered  more  fully  in  an  analysis  of  the  influence  of 
exercises  of  effort  and  endurance  on  the  circulation. 

The  measurement,  then,  of  arterial  tension  is  exceedingly 
important.    This  is  done  by  a  sphygmomanometer,  such  as  Stan- 


THE  PHYSIOLOGY  OF   EXERCISE  ^5 

ton's  modification  of  the  Riva-Rocci  instrument.  Tl,e  brachial 
artery  ,s  compre^  by  strapping  around  the  arm  .  lea  her  co^ 
four  mches  ,n  w.d.h,  beneath  which  is  a  rubber  tube,  the  a  bdnJ 
pumped  mto  .t  until  the  radial  pulse  is  obliterated.  The  _ 
of  pressure  requ.red  .0  do  this  is  measurd  by  the  heUrof  a 
column^of  mercury  forced  into  a  graduated  u^ight  ^  It 

The  normal  systolic  pres.sure,  according  to  Janeway  who  him 

H  r:  '" '"'"™''"' ''  '^^-  ""■■'""'=«--  Any  ii  u„dT; 

160  he  does  not  consider  abnormal.  *' 

Sir  Lauder  Brunton's  observations  give  120  as  nnrm,i  f 

young  adults   and  from  r.5  .0  r^o  for  men       m  dd  e Te    Z 

ons.ders  anything  above  150  us  abnormal,  although  h   no     'ha" 

mg  found  men  apparently  in  good  health  with  a  pressure       Z' 

C;t"o      "'   r'"'-  '"  "=  '■"  '^  I—o-  condition. 

by  Dr  T  E  '^  f ""?"  '''™  "■'■"'  ""=  ^""«''"  --hine, 
by  Dr.  A  t.  Newton  and  myself  on  college  students  IvinJ 
2'ne,   shows  an  average  of  X35,  „hich   is  Ler      an  jt" 

Zra-dlr'  '''  ^-^  -  '-"  ^-^-  «™"-'^  "^  — 

The  observations  of  O.  Z  Stenhpn=  ■   ,„ 
showed  the  following  mean  pre^l^s^^a  "di  g^'!::  r;r;' 
;^«ne,  ,50.4;  head  down,  .,,,,  Wght  lataf,  .3;.5    ^^ 

In  e.erci.^s  of  effort  or  speed,  such  as  lifting  a  heavy  weight 
Chest  wall  that  ass.st  m  supporting  the  arm  and  shoulder  come 
Z.T":  ^™'^^f-'P---ns  on  the  elastic  cushion  otl 

'  "Journal  Aw.  Med.  Asxt,."  On.  ,    ,„  , 


3*  EXERCISE   IX   EDl-CATIOX   AND  MEDICINE 

ishment  to  the  heart,  are  compressed,  and  the  circulation  of  the 
heart-muscle  partially  arrested,  while  the  refilling  of  the  thin- 
walled  auricles  is  hindered.  The  bloal  i„  the  arterial  system  is 
dammed  back  by  the  resistance  in  the  engorged  veins,  and  the 
superficial  veins  of  the  neck,  temples,  and  forehead  swell  up  like 
cords  (see  Fig.  i),  and  the  complexion  becomes  first  red  and  then 
dusky. 

The  blowl-pressure  mounted  to  over  300  mm.  in  a  series  of 
experiments  by  xMcCurdy'  in  a  back  and  leg  lift  in  which  the  effort 
was  maximum,  but  the  bloal-pressure  fell  at  once  when  the  ob- 


Mnltft. 

'*m* 

l-JaiiHMAn 

ll«w. 

*m- 

•tr 

UlM. 

^- 

Ul. 

Pi*. 

cmj 

PidM 

Ik 

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ID 

IM 

M 

in 

lU 

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» 

11* 

n 

in> 

lU 

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Dft 

X 

at 

1:1 

n 

M 

1« 

n 

s*. 

a 

la 

a 

100 

1T( 

« 

" 

n 

173 

n 

114 

in 

n 

" 

in 

V 

117 

197 

10 

« 

«t 

iw 

n 

m 

m 

n 

HL 

» 

«• 

HI 

»4 

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154 

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Ul 

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Hi. 

n 

n 

M 

M 

107 

IM 

71 

116 

» 

" 

lU 

n 

127 

»r 

»4 

UO 

l-f 

Fig.  II.— Summary  of  experiment  made  by  J.  H.  McCurdy. 

struction  <o  the  return  flow  was  removed,  equilibrium  in  the  circu- 
lation beu.  rapidly  established,  and  little  acceleration  of  the  pulse- 
rate  being  noted  (see  Fig.  11).  the  disturbance  above  described 
v^ring  directly  with  the  severity  and  length  of  the  effort.  We  find 
then  the  greatest  strain  on  the  heart  and  blood-vessels  in  exercises 
of  strength  and  speed,  more  especially  in  all  feats  where  the  arms 
are  used  to  lift  or  pull  great  weights,  or  to  support  the  body,  these 
movements  involving  as  they  do  fixation  of  the  chest-walls 

From  the  above  it  will  be  clear  that  exercises  requiring  sudden 

'  "  .\m.  Journal  „f  Physiology,"  Mar.  i,  1901. 


THE   PHYSIOLOGY   OF  EXERCISE  ^j 

and  great  muscular  effort  should  be  used  «.!,h       .■      ■ 
"hose  arteries  have  lost  the  first  r,i-  ,      "*"'"'"  '"  ""^1 

'lamage  may  easily  ocTur  althour      ''  °!  ""'''''  '"'  '"  ""^ 
can  be  violent  en/ughTo^^^rtl^tseT  'tT'  '"""^ 
are  a  test  of  their  quality  rather  th»n  "^  '""^'^s 

developing  them,  andl^sylt  „,   "v'-'^r":  "'  '^^"'"""-ally 
exclusively  of  such  exercise,  r»^  1    ^^         "'""""'"  ™'"l«>«'l 
It  is  to  exercises  of  e^lr    1'  ^"''  ''"'■"•  '"  -^"""Pleteness. 
.ematic  '.evelopm:„rof  s  ^ra    rrJ.""'  '°°l '"  '"^  ^>^- 

--xn  mild,  rhythmic  si::;:m:;-:::«- 


normal  much  more  slowly  h'  ^h  ,'  ""'^  ""="  "^^P  '°  ^b- 
nses  abruptly,  remain  hi  h  '^  P"'^^-^^'«-  The  pulse-rate 
of  the  exeLi;  Du:^/^'^.  •  :i'™|;^    -^''-ly  a.    the  end 

on  with  increased  force  and  IpdTbut-r'""'"  "  ^""'«' 
(Fig.  12).  '"''"^"y'  ''"t  without  great  overstrain 

^^  potent  influence  than  resistance  in  raising  this 


3»  EXEKCISE  IN  KDLCATION  AND  MEDICINi: 

Owing  to  the  profound  influence  of  exercise  on  constitutional 
vigor,  It  should  be  regulated  with  great  care  in  relation  to  the  age 
of  the  patient.  According  to  Benlse's  sUtement,  the  volume  of 
the  heart  in  children  is  to  the  diameter  of  the  arteries  as  35  to  » 
in  adolescence  it  is  140  to  50,  after  full  maturity,  ago  to  61.  During 
this  iwriod  the  volume  of  the  heart  is  increasiti  twelvefold,  while 
the  diameter  of  the  arteries  is  increased  only  threefold. 

If  the  length  of  the  body  be  considered  as  100,  the  heart 
volume  would  be  from  40  to  50  in  the  child,  while  the  heart  of 
a  mature  person  would  be  190.  The  child's  growth  then  would 
be  in  relation  to  and  dependent  upon  this  development  of  the 
heart,  and  upon  the  possibility  of  increased  pressure  of  the  blood 
in  the  arteries  caused  by  their  proportionate  narrowing. 

"Athletic  training  is  mainly  heart  training.'"  Exercises  of 
endurance  distribute  the  activity  widely,  and  gradually  approach 
the  maximum  without  interfering  mechanically  with  the  respi 
ratory  movements.  They  do  not  r«iuirc  supremo  efforts,  but 
they  accelerate  the  activity  of  the  heart  and  lungs,  at  least  so 
long  as  the  exercise  lasts.  The  aggregate  of  work  done  is  very 
much  greater  than  in  exercises  of  strength.  Such  exercises  must 
however,  be  active  enough  to  provide  for  the  free  circulation  of 
the  lymph,  which  is  carried  on  mainly  by  the  massage  of  muscular 
contraction.  If  a  walk  be  listless  enough,  there  may  not  be  suffi- 
cient movement  of  the  muscles  to  thwart  the  pernicious  influence 
of  gravity  acting  on  the  column  of  blood  contained  in  the  veins 
of  the  belly,  thighs,  and  legs,  and  the  vessel  walls  may  still  become 
permanently  stretched  and  varicose. 

Massage  mechanically  excites  the  vessels  to  action,  empties 
the  lymph-spaces,  and  hastens  the  circulation.  It  usually  raises 
the  general  body  temperature'  as  well  as  the  part  manipulated,  and 
through  these  means  it  removes  fatigue  products,  increasing  the 
muscle  irritability  lost  from  overwork  or  disease. 

Many  mo;ements  may  be  chosen  because  of  the  automatic 
massage  given  to  the  larger  vessels  by  the  action  of  the  limbs  as 

"Weir  Mitchell,  "Fat  and  Bloud."  " 


TWE  wnrsioiooY  or  exmcme 


39 


thigh  b^  turned  "nl^Xd  fl'L  Th"!  V"  ""f"'''"i  "•  "  ""^ 
vein  wall  connected  ^T  i^  'TJ '^"^^ 'T''' '''' 
enlarging  it.  „  .he  th.Kh  .«  „2  cotple  ,y  fl'e^  r''"'""^ 
pressure  in  again  exerted  on  the  vein     Thl?^  .u  '"'""^' 

lower  centers  in  the  hinH  K    .    ^   ,  *"'  °'  ""em  is  turned  over  to 

.he  High,  reii^^d'-cirn^rrdtrrrHr-"^^"^ 

coord  nations  that  arp  n.,™      /  ■«  "•^voiea  to  those  accessory 

-o™ehahi.ua^!!:^r™5;^^^^^^^^^ 

than"^  r  ~"f ^*f  •'■'•r  •  '^  '^^'"'"^  °' '' ^  --  --er 
this  connectTon!  "^     '"'"'  '"  '^^  "'  '"^  -P"a'ely  i„ 

nis.ic%oups?hrhr:;e:;raSatr^^  ='"■'''"'''«''- 
movement  is  unfamiliar,  this  c^ntrac  iontw^l  h  7""  J'  "  "'^ 
ate  instead  of  unerring  ' 'T         '  f  ^  J"''>'  *"<!  '""""r- 

ically  econom  cal    Zv     T'      '  "' '"  ""'"  ™^''''  Phy-^'os- 

expeLirnentsX^rt^eTttf^^^^^^ 

The  first  attemnf  ,,  ^  proportion  to  the  result 

the  allir  ?h  ':zx '  r""''^  r '■""  ^'^"'^'^  '^^''-- 

of  a  child  iearni  to  TS.:™  ":  '"'  """'^'■"  ""'^^-'^ 

a.  arst  re,uir«,  i^n  .hat  aVrrh:lrallr ""''■"" 

E^ercises  of  slcil,  cultivate  habits  of  economy  int  ^.pendi.ure 


40  EXEICISE  IN  EDlCAnON  AND  MEDICINE 

of  nerve  forcc^  «,d  we  in,.,„clively  admire  a  .lifficult  cxerciK 
performed  «„h  thr.f.y  ea«  ju».  «,  we  uncon«iouJy  cen,ure  the 
ner,ou»  prodiKal.ty  of  ,he  umkilful  tyro.  The  .lis.rac.ing  influ- 
ence  of  mental  exc.tement  or  wor^r  is  «.tn  in  the  broken  sh.  -Uce 

:^£ur„r '"" "-  '"■""'  °' "-  "'-•'"»  •"•"'" »-'-  • 

When  a  certain  degree  of  skill  or  coordination  h  leame,!  the 
interest  ,»»e»  on  to  what  i,  more  difficult,  and  this  ,,  one  reason 
why  atiy  course  m  physical  training  should  begin  with  simple  ami 
easily  Icarncl  coordinations.  progre«.ing  to  those  more  .lifficult 

r^er^ll'CI^r  """  "^^  *"  ^"^  ""^^  '"*  '"--  «"" 
Exercise  should  also  be  „esigned  to  develop  and  educate 
movements  that  are  peculiar  to  the  limb,  the  lower  limb  for  support 
ocomotion.and  leaping;  the  upper  limb  for  grasping,  string, 
throwmg.  and  catching.  It  is  because  this  great  principle  is  » 
much  neglectcl  that  the  interest  is  difficult  to  maintain  in 
formal  gymnastics.     In  free  play  this  takes  care  of  itself 

Exercises  of  strength  and  skill  train  that  alertness  of  mind  so 
r'T7  !f  """'"'^  ''■'"•    '^^'^  '''«'«<^"   ">«  r«rio<l   between 

of  mind.      This  cannot  be  done  without  a  corresponding  mental 
stram.    The  man  who  is  held  alert  too  long  on  the  starting  line 
before  a  race  tense  an,l  straining  for  the  signal,  finds  such  a  rapid 
exhaustion  of  his  powers  of  concentration  that  in  a  second  or  two 
the  stra  n  becomes  intolerable.    The  alertness  required  at  first 
m  learning  to  box,  rapidly  exhausts  the  nervous  system,  and  it 
IS  only  when  the  movements  of  countering,  ducking,  ant'     ide- 
steppmg  become  habitual  that  the  exercise  can  be  continued  for 
any  ength  of  t.me.     Football  is  a  game  of  the  same  nature,  and 
getting  the  jump    on  an  opponent  is  a  matter  of  mental  concen- 
tration and  alertness  rather  than  of  actual  strength.    Much  of  the 
exhaustion  of  a  game  is  due  to  this  brain-fag,  for  the  actual  play- 
ing time  in  an  hour's  game  is  only  four  or  five  minutes  at  the  most 
In  gymnastic  exercLses  imitation  is  a  cheap  form  of  instruction 
from  the  standi^mt  of  ner^-ous  expenditure,  because  the  pupil 


THE  PHYMotOOY  ur  EXKRCWK 

can  walk  or  run  ami  have  h,  "•,  ^""""""""n-  A  man 
when  .hey  are  carrM  '  .';  .r.".:"  '"^■' /"!"«'•  ''"' 
phenomena  of  brea.hle^ness,  realT  leiTT;  '"'t''  ""= 
the  exercise  tx>  con.mue,!  af.e  br™  Ute^  h!  p'"  '''''^'';  " 
runner  soon  begins  ,o  notice  a  Jnl.i™  of^  "  <  '«PI«ar«l,  ,he 
him,  shown  by  an  increasin„  iTth  "'^'""''^  "'^^•P"'K  "ver 

power.  His  L.C';ZZ  i^LuoC S  "'  '''  ''" 
to  his  will;  each  effort  require,  a  ^T,Z  "'''°"'* 

attention.  This  lassitude  KrZlly  rtlL- """"'""  ""  "'  ■"' 
of  muscles  refu.se  ,o  perform  heXtru'lilT"'  '"  T"" 
with  relaxed  grip,  yielding  ankle    f,n-  "*'«"''  "'""« 

Repeated  attacks  of  fatigue  nro<luce  th,t     ^       • 

apparatus.  ""'K"^an  mtox.cafon  of  the  breathing 

expense  of  nervous  CereSToTt.r'"'^'"'^  ""'"'"'  ""^ 
^«e  acts  on  the  centra.  sXtou^tht™™:'' '""'  ™'- 

ifpi.r~^- '°  '^^  n-mz-r/x 

actii::^:ri:-:S'-^  -  P-ins  by  muscular 
'iuces  a  hunger  for  L  ^l^t  ^^  „f  Zf  th  ™  ''■'^ 
-se  m  si.e  and  strength,  and  the  alU^tli^ "d 't 


4» 


EXERCISE  IN   EDUCATION  AND  MEDICINE 


excreted    or    stored    up    in    the    tissues    as    fat.     If  training  be 
severe,  this  natural  horde  of  fat  is  speedily  expended,  and  a  man 
in    fine   athletic  condition  is   always  below  his    normal  in  fatty 
tissue.     Athletic  training  aims  to  produce  a   machine  to  run, 
leap,  fight,  or  row,  and   fat   would  only  be  an  encumbrance,  so 
that  a  man  in  fine  athletic  form  would  not  be  in  the  best  con- 
dition to  resist  the  siege  of  an  exhausting  infection,  like  typhoid 
fever   or   pneumonia,    where    the    stored-up    fat  of   the  normal 
Individual  becomes  his  most  valuable  asset.     The  loss  of  weight 
diu-ing  athletic  exercise  may  be  from  five  to  eight  pounds  in  less 
than  half  an  hour,  a  loss  which  is  continued  after  exercise  is  stopped 
if  no  food  or  drink  is  taken.    In  a  series  of  observations  made  on 
foot-ball  players  during  practice  at  the  University  of  Pennsylvania 
I  found  that  the  loss  averaged  about  three  pounds,  the  highest 
being  5.1  pounds  and  the  lowest  .8  pounds,   the  weights  being 
taken  immediately  before  and   after  exercise.    The   men  were 
then  wrapped  in  blankets  or  allowed  to  sit  around  for  an  hour,  and 
showed  a  further  loss  of  one-half  jjound,  the  greatest  loss  being  .9 
jraunds  and  the  smallest  nothing.    In  no  case  was  any  gain  found.' 
It  has  already  been  shown  that  the  first  two  organs  to  act  in 
the  elimination  of  the  poisons  of  muscular  waste  are  the  lungs  and 
the  skin,  the  former  giving  off  heat,  CO,,  and  water  vapor,  and 
the  latter,  water,  urea,  and  other  constituents  of  minor  importance, 
in  addition  to  neutralizing  the  heat  produced  by  muscular  action 
thri-ugh   evaijoration.     This   loss  of  weight  from  the  skin  and 
lungs  goes  on  even  during  sleep,  as  shown  by  the  delicate  bal- 
ance used  by  Warren  P.  Lombard  in  his  experiments'  (Fig.  13). 
From  107  observations  on  healthy  men  averaging  64.5  kilos 
in  weight  he  concludes  that  the  loss  of  weight  is  0.692  gm.   a 
minute,   of  which   .525   is  from   the  air  passages  and  .166  or 
about  24  per  cent,  is  from  the  skin.      The  elimination  by  the 
skin  alone  was  obtained  by  holding  the  breath  in  expiration. 

'  For  the  carrying  out  ot  ihese  ex|»rimenls  I  am  indebted  to  mv  assistant,  \V. 
J.  Oomie. 

'Rejiorled  at  tlie  Siclienler  Inlernationakr  Physiologen-fungress,  Hfidelliurg, 


THE   PHYSIOLOGY  OF   EXERCISE  „ 

The  effect  of  CO=  has  b«.n  «„   ! -clly  shown  bv  Lee  in  his 
work  on  the  action  of  fatieue   .'.«i,„'.  ,/„        i 

ui  idiigue     .kIucls  or,  "i.^-ular  contraction. 


Fig.  13.— Curve  ot  loss  of  neiBhi  of  F    M    1    (,„   1 

small  oscillalion,  were  lause.l  bv  the  y^,,Z'JL.  t'  ^>'^"'"'""'  55  deKrecs.  The- 
bollom  of  the  curve:  „-6,  sul.jc^  a"'e^„  7  .•  ^"""  "  "'"'""'  ">  ■"'""'"  «■  the 
waki„„  curve;  at  ,,  breath  held  iu  quiet  ..xoiraHon'Tt/""'!'  "'  '•  ■*  """"'  "'''"'•  ''-■■ 
ject  be„in,  ,„  breathei/-j,  curve  sh„«s  rn^H  "'■'^^.\'"l!=  ■"•Piralio,,  when  sub- 

.he  breath.  ..t  *,  he  ™  »rtl  a  eep  ef  c^ed  hT  '  '°',l°'""«  ""  '■""'•"'  "< 
ope,,  his  eyes  and  did  so.     He  w.as  not  starded  !,? '  '""■     "'  ""»  '"'''  '" 

movement  (Warren  P.  Lombard)  ""  ""'  "■'"   '"  "'"'"  ^'"J'  ""'" 

In  Kig  14  the  preliminary  stimulation  of  the  poison,  already- 
referral  .0.  .s  seen  n  the  higher  cur^e  of  contraction  found t 
the   potson..!    muscle  at  the  lower  part  of  the  diagram       This 


horma"  the  other  unde/  th  Tfl  ''""^"T  ^^""'""''-  "■""le,  of  the  fr„«,  one 
contractions,  .he  o^er  cuilt  are"Z  Al'^"-  ''""''■  '^'"  "^'"'  ■>'■  ■"  '^"<" 
tion  is  reco,;jed  (Frieric  S  l"'  ""'"""'  """'''■     ^'"'  ''"'""  """»- 

Stimulation  soon  gives  place  to  the  slo«-  and  lowered  line  of  the 
upper  part  of  the  diagram. 


44 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


It  Still  remains  to  speak  of  the  function  of  the  kidneys     Before 
a^  after  the  Marathon  race,  of  twenty-four  ntiles,  at'st.  Lol 

h^^i  '"fr''''""''"'"""'^"'--'«''™(PerrecrumT^ 

showing  a  nse  of  from  .  to  3?  degrees.    This  rise,  also  r.tTby 
Bowen  (F,g   „),  ;,,  j  believe,  constant,  although  i  may  no  show 
if  the  mouth  temperature  be  taken      Th„  f„       • 
nephritis  lasting  ^veral  Z^T.J^l  Te^SSo^ 

removed  by  the  ktdneys  are  water,  uric  acid,  urea,  oxalates 
lithates,  and  numerous  other  substances.  These  show  as  reH^nv,' 
deposits  (principaV,  uric  acid)  in  the  urine  esZiluv  of  hn  ^ 
Habituat«l  to  fatigue,  but  quickly  disappea;  X 3^1:^'^^ 

In  the  understanding  of  the  place  occupied  by  c^ditianm, 
and  elnnmation  we  have  not  advanced  much,  even  TTZ 

he»  1/  ^'T  f"  ""'^  '''"'  themselves,  the  bo<iy  becomes 
heated  and  they  y,el,l  the  product  of  liquefaction  ,„  abundance 
Of  ,h,s.  whatever  ,s  sweated  or  purged  away  with  the  brea.h"cause" 
no  troubk  except  to  so  much  of  the  body  as  has  undergone  the 

to  h^  undTlvT; '; H  ''"''''"  ^'^"'""^  ^^-^  trouble," 
o  the  unduly  depleted  part  of  the  body,  but  also  to  whatever  part 
rece,«s  the  h,u,d  in  question,  which  is  not  akin  to  .hetd;,'but 


'Notes  taken  by  Up, 
MtKenzie. 


Luther  Ilal«,y  (iulick,  J„„ph  E.  Raj.„ot,,  R.  Tai, 


CHAPTER    III 
MASSAGE  AND  PASSIVE  MOTIONS 

accounts  of  their  emU^'en  in -^Zy  AwLs^ 

Japan,  China,  and  the^•s,ands  of  hT  P    ific'     Tr'/"^^^^^^ 
of   the   SanHii.,VK    Ti     j        .  racinc.     Ihe  lomi  lonii 

procuring  resttd'X     ^'r^sTr  t  f '■^"^'  ='"" 

-.refreshing  se„rofearr„d'Zr '  "''"^  ^'^^^  '°  ^ 
^"e  history  of  massage  has  been  checkered     Th.      •    .      , 

acquired  ereat  skill  in  .1,  •     f  .    '"''^'     "^  physicians,  who 

era!  massage.    It  has  had  its  eras  of  popularity  and  its 

4S 


46 


LXKRCISE   IN    EDUCATION   AND   MEDICINE 


seasons  of  neglect,  popularity  usually  due  to  the  personality  and 
skill  of  an  operator,  or  school  of  operators,  and  neglect  following 
its  indiscriminate  use  by  unskilled  persons.  In  the  middle  of  the 
last  century  Beveridges'  rubbers  were  well  known  in  Edinburgh, 
and  their  success  carried  it  from  that  medical  center  throughout 
Europe.  It  then  declined,  but  has  been  revived  on  a  more  solid 
and  scientific  basis  by  Fox,  Xorstrom,  Graham,  and  especially 
by  Mezger,  of  Amsterdam,  whose  classification  is  the  one  hab- 
itually follo";,.d  to  the  present  day.  It  is  universally  employed 
by  athletic  trainers  to  aid  the  elasticity  and  power  of  an 
athlete's  muscle,  before  a  contest  and  to  remove  the  fatigue  fol- 
lowing exertion. 

In  medicine  a  great  impetus  was  given  to  its  employment  by 
Ling  and  his  disciples  in  Sweden,  and  it  now  forms  part  of  the 
Swedish  system  of  remedial  gymnastics. 

Its  recognition  as  a  therapeutic  agent  has  been  delayed  by 
the  fcilure  t-^  distinguish  between  true  massage  and  unskilled 
rubbing,  which  merely  requires  muscular  strength,  a  certain 
manual  dexterity,  and  good  will.  To  be  a  successful  masseur  one 
must  possess  these  qualities  before  beginning  the  training  necessary 
to  learn  its  possibilities,  but  its  practice  should  be  preceded  by  an 
intimate  and  special  knowledge  of  anatomy,  the  disposition  and 
thickness  of  muscle  grouDs,  their  septa,  the  point  where  muscle 
changes  to  tendon,  the  situation  and  course  of  the  veins  and 
arteries,  and  their  anastomoses,  the  location  of  the  nerve-supply, 
the  movements  of  a  limb,  and  the  changes  about  the  Joint  caused 
by  movement,  the  situation  and  extent  of  synovial  cavities  and 
tendon-sheaths.  This  knowledge  should  be  practical  and  con- 
tinually confirmed  or  corrected  when  the  parts  are  at  rest  and  at 
work.  In  aldition  to  this  there  must  be  that  touch,  firm,  insistent, 
yet  gentle,  that  adapts  itself  to  the  hills  and  hollows  of  the  body 
surface  as  if  by  instinct,  and  a  buoyant  constitutional  vigor  to 
withstand  the  exhausting  character  of  its  practice.  It  is  for  the 
reasons  above  enumerated  that  the  practice  of  true  massage  is 
limited  to  the  few  that  are  willing  and  able  to  devote  the  time  and 
study  necessary  for  the  thorough  acquirement  of  its  technic. 


MASSAGE  AND  PASSIVE  MOTIONS  47 

The  action  of  massage  upon  muscles  in  reiiosc  has  been  thor- 
oughly studied  by  Mosso  and  Maggiora,  of  Turin,  who  chose  for 
the.r  experiments  the  fatigue  curves  of  the  right  and  left  mi.ldle 
fingers  m  maximum  voluntary  flexion  every  t«o  seconds  with  a 
weight  of  three  kilos.'  These  records  were  taken  at  eight  and 
eleven  m  the  morning  .nd  at  two  and  five  in  the  afternoon,  with- 
out massage,  and  the  following  day  .mder  the  same  conditions  after 
a  friction  and  kneading  of  three  minutes.  The  average  of  the  re- 
sults iiroved  that  the  muscles  did  twice  as  much  work  after  the 


Fig.  16. 

FiB.   ..^-Normal  voluntary  curve  of  fatigue  of  the  flexor  muscle,  of  the  middle  f„,„.r 

Fi.    ,6      A  Wt"""'  """  "  "'■'«'"  "'  '  '"■'"  ""■'  '!'>■"'">  of  two  second.. 

1-.K.   .6.-rurve  of  the  „me  muscle,  with  the  -ame  weight  and  rhythm,  after  n„us,,agc 
for  three  mmutes  (after  Maggiora). 

massage  (Figs.  16  and  18).  Maggiora  also  discovered  that  exten- 
sion of  the  period  of  massage  did  not  produce  any  greater  results 
m  the  capacity  for  work,  five  minutes  obtaining  all  the  neetlful 
ettect.  His  experiments  on  the  comparati-e  value  of  the  various 
manipulations  proved  that  little  difference  existed  in  the  effect  of 
friction  and  percussion.  There  was  a  greater  increase  of  work- 
■ng  capacity  after  the  use  of  petrissage  than  from  either  of  the 
other  movements,  but  the  best  results  were  obtained  by  alter- 
nating   all    three.     The    effect    of   mas^^ge   upon    the  muscles 

'  liraham,  "  Xecent  Derelopments  in  Manage." 


1  i   ! 


48 


EXERCISK    IN    EDICATION   AND   MEDICINE 


weakened  by  fasting  was  .uch  as  .0  restore  the-,  temporarny  to 
her  normal  condition.  It  also  restored  a  normal  fat.^ue  un^ 
that  „,s  reduced  and  shortencl  by  a  wakeful  night  (Fi." 

o  rsln  th    r  T  '■"'™^"  '""'""""'  ■■"'ellcc.ual  strain  of  nc 
hours  m  the  final  examination  of  medical  students,  Maggiora's 
fa  .gue  curve    was    one-fifth  of    the    normal.     An    hour     a ' 
after    ten    minutes    of    massage,    the   fatigue   curve    ralmol; 
completely    restored.     Perhaps    .he    mos't     intere  ti  g      S 


gior;,).  •   »-'«'"K-     "  "gill,  3  kilos  ;  rhythm,  two  si-conds  (Mag- 

Obtained  were  in  his  studies  of  artificial  anemia  of  the  muscles 
01^^^   ™Zr7com   ''"^'""  "'^^'  '''  '"^"  -"'<»  "™ 


I 


MASSAGi:    AM)    PASSIVE    MOTIONS 

49 

moWn«   Iht  |«Mnm,-  |,r<xlucN  l,^^„,    ,,..   j,,^;,        , 


Fin. 
1%. 


■Fa„g„.  ™„.e  „r   „.„,  ,„  „,  „„^,^^  ^,  ^^.^^_  ^^^_^  ^^^_^ 

iiv..ikv  one  rirght.  ^ 

enaUe^anathlCe  ..,  ...at  ,.  continue  a  perfo^anc.  oth.nWse 
Massage  differs  ra-lically  from  active  exercise  in  i„  ear,acitv 


5" 


EXERCISE  IN    EDLCATIO.N  AXD  MEDlnXK 


■  !! 


current  forward  in  the  lymph-spaces  and  venous  channels  It 
thus  stimulates  the  circulation,  res,.iration,  nutrition,  ami  ex- 
cretion. 

.Mezger  gives  the  best  classillcation  of  i>r<K.ecIures,  .lescribing 
four  principal  manipulations: 

I.  Stroking  (effleurage),  in  which  the  hand  is  passed  lightly 
over  the  skin.with  pressure  from  the  periphery  to  the  center,  follow- 
mg  the  course  of  the  venous  circulation  anfl  the  long  direction  of 
the  muscles  from  their  insertion  to  their  origin.    It  may  be  i)er- 


FlB.  ...-KmauraKO  of  ,hc  tor„rm.     NW  the  di.,e„,ic„  „f  ,h..  v.-in.  „l„v.  ,h,  hnnd 
ihut  is  pa-fsin^  upward. 

formed  by  stroking  with  the  palm  „f  one  or  both  hands,  with  the 
thumb  or  tips  of  the  fingers.  The  two  hands  are  userl  upon  the 
large  fleshy  parts  of  the  thighs  and  buttocks,  or  upon  the  ch.st 
back,  and  neck.  The  thumb  is  used  on  small  muscles  hemmed  in 
by  bones,  such  as  the  interossei  of  the  hand  or  foot,  or  the  anterior 
muscles  of  the  leg.  The  tips  of  the  fingers  are  used  around  the 
jomts  of  the  knee,  ankle,  elbow,  or  wrist,  the  fingers  adapting 
themselves  to  the  shape  of  the  part  ;.orked  upon.  The  strength 
of  the  manipulations  varies  from  the  slightest  touch  upon  a 
region  sensitive  to  pressure,  to  the  firm  pressure  with  one  hand 


I 


MASSAGK   AND   PASSIVK   MOTIOXS 


St 


upon  the  other,  over  such   Jaa"-  nn i. 

Inflammatory  pro,lucts  are  1,1.    n  T         T-         """'"'  'i"'^' 
ami    rapiHIy    al^'n  "•, .""^"'•■'''  i"''^'^  '"'o  the  circulation, 

in«  the  ::or;tt::;r:::,r  ™""'  -"  -'■'™'  ™""'- 
the?humrz';;;r;-""p "'?'" ""'"""™' '-'"™"'  -'y 


^y^:r:.h:  :^;?;:'.i  Srrf  ^™""'' -'-^^ 

the  entire  han..     Th'e  iricSo^M  M   ^thr"  ^"'"™^' 
flirection  as  the  strnkin,,  m^  I>r«:eccl  m  the  same  genera 


5» 


KXIKCISK   IX    EUfC.vriON    .\M,   MKDK  IXI: 


3-  P.trl...g,,  pinching,  or  gr.iping  i,  pirformcl  bvpick- 
inj,'  up  the  skin  an.l  sulK-utanmus  tissue  l,ct«trn  the  thumi,  an<l 
fmKcrs,  an.l  manipulatinK  it  with  an  amount  of  (ore.  not  sumcient 
to  cause  pam.  In  this  movement  the  skin  mo^es  with  the  han.l 
of  the  operator,  an,l  the  im-lerlyinK  structures  are  thus  massa.-e-l 
by  .t  under  the  pressure  of  the  (infers.  I,  i.  „,,,,  a.Uan- 
taKcously  done  l,y  the  thumb  oppose,!  to  the  llrst  linKer,  bv  the 
finders  «p,H,se,!  to  the  palm  of  the  han,l.  or  bv  tl,e  two  liun,!, 
oppose,!  1,.  one  an,.ther.  The  thuml,  and  lingers  are  use,!  to  reach 
m.hvKlual  muscles  an.l  small  groups,  such  as  the  muscles  of  the 
Han,!,  f,x,t,  forearm,  an.l  upper  arm.     The  larger  muscle  masses 


of  the  th.Kh  an,!  calf  re,|uire  the  use  of  th.-  lingers  oppose,!  to 
the  thumb  and  ham!  (Fig.  23),  or  both  han.ls.  the  muscle  bcini; 
rolled  beneath  them  and  presse,!  against  the  Imnc.  This  has  the 
same  elTect  as  friction  on  the  ,leep  structures,  an,!  is  better  for  sen- 
sitive, easily  irritated  surfaces,  the  skin  moving  with  the  han,!  like 
a  glove.  The  movement  shoul,!  always  \k  gradual,  proceeding 
from  the  periphery  inward.  It  is  the  favorite  means  used  to 
improve  muscular  nutrition  in  conditions  of  fatigue,  in  atrophy 
in  obesity,  or  other  forms  o:  muscular  ,!egeneration. 

4.  Strikingdapotement  or  Percussion) .-This manipulation 
comes  under  many  names,  such  as  clapping,  locating,  knocking  or 


UASSACK    AM)    PASSIVK    MOTIONS  j, 

hackinK.     It  is  .lone  f„r  small  surfaces  l.y  patting  ,,,.1,  .he-  „,«,■« 
haml,  „r  l.y  .lapping  with  .he  palm  cuppcil  „,  Lve  a  hv    "" 

a,T   ,,        •  u    T        "'  "-^'O' fr^'l'"'ntcr  of  ,hc.  Turkish 

U  h^  hsa...,„  on  ,he skin,  supcrrtcial  „cr^.s,  an,I  v.ssds  is  stim.. 

-  I    ;  u"      In'"  ""'T'  "'■'"  "'^'  "'""  '-"""f  'He-  hand, 

•It  th,.  ..„ii  ,       ".   '  "'■  '"'"'■■  ''^'''  ^l'^"-'  f"  till-  skin 

■"  'l-anklc-  or  knc.c.-join,s  or  in  manipulations  of  .he  scalp,  ,]": 


-  TaiK.ion,rnt  ..f  H,,.  |„„.k  „.i.h  th,-  ul 


>f  th.-  Ji;ipkN. 


movement  shoukl  he  performed  bv  the  tins  of ,',    r 

cai.in™,unt:^Lr.,rs:;:r;ctr'"' 

'-ise  the  muscle  an,l  pr'X    ^  ^  '/l:'  t?  '■"""«"  I" 
used  m  cases  of  paralysis,  neuralgia,  a^^^inti!'  '^  """™""'^ 

-.orr..nremr:;:---:rr:-- 


54  EXEICUE  IN  EOUCAHON  AND  lltBICINL 

General  massage  i.  l«s,  given  at  an  hour  mM„ay  l«tween 
meals,  and  never  immerlialelv  after  eatinu  TK  '7'. '*'"'«" 
the  manipulations  are  Ki,e„  is  as  folln»  T.  "  '"  "'"''' 
lubricated  with  cocoa-blltte  r  al  "^o  a  JdT  ""  ""' 
which  may  follow  the  friction  of  atat    urf^e     Th    '"        '" 

ihnml  1  <■  '  ""*"  ''™"  covcrec.     With  the 

thumbs  and  fingers,  the  small  muscle,  of  the  foot  are  kneadLl 
specal  attention  being  .levoted  to  the  interosseo"  gZ  '    whS 

foot     The  leg  ,s  next  treated  by  circular  friction  with  the  fingers 

3^^ir^^'t^^c:;r---r5 
5-Ke^:^^r:^:a^^a^s;^— -t 

bs     A?h  ^,"'  ™""*  ""•^"^  "'<'  ^"^hions  of  the  finger- 

unee,  to  lavor  the  flow  of  venous  blood-riirr™.=    tu 
is  carried  on  for  the  hands  and    hT^trT  Esirr: '-"""^ 
g.ven  to  themuscles  of  the  loins,  back  and  neck  u^A  k-  ""^ 

to  Actions  kneading,  and  strikin;^^  S    t^r'^rlS 

back,  the  same  manipulation  being  directed  downward  and 


MASSAGE  AND  PASSIVE  MOTIONS  j, 

out«ar<l  from  the  hca.l  to  the  shoulders.  The  abdomen  is  then 
treated  by  pinchinK  the  skin  and  underlying  tissue,  deeply  Krasi, 
ing  the  entire  muscular  walls  with  both  hands,  pinching  ami 
rollmK  them.  Mas.,age  of  this  region  conclu.les  with  <leep  knea.l- 
ing  by  the  heel  of  the  hand  in  a  succession  of  rapid  dee,, 
movements  passing  clockwi.se  in  the  direction  of  the  colon.  The 
chest  ,s  then  manipulated  upward  from  the  sternum  along  the 
Ime  of  the  pectoral  mu.*les  by  pinching  and  kneading  of  the 
muscle  mas.,..s  of  each  side.  The  face  is  not  usually  treat«l  in 
general  ma.s.«.ge  but  the  si.les  of  the  nc^k  are  gently  strokcl  from 
al»ve  downward  along  the  course  of  the  internal  jugular  veins 
Each  part  operate.1  u,x>n  should  be  carefully  covered  af.e^ 
treatment. 

Weir  Mitchell,  in  his  treatment  of  neurasthenia  by  rest 
overfeedmg,and  general  massage,  found  a  constant  rise  of  tem,«ra 
ure  after  each  treatment,  and  not«l  a  rapid  improvement  iithe 
tone  and  reaction  of  the  whole  muscular  system 

oJul  "'Tr  '"""  'r  «'""«  "''^^^  '^  """  '«>  ""•'h  i^  given  at 
onc.,me-Magg,ora-s  experiments  prove  that  the  maximum  effect 
on  a  part  ,s  obtamed  in  five  minutes.  Another  mistake  isTn 
employing  too  heavy  a  hand:  a  patient  should  never  feel  bru  Jd 

riiuitrfft:"^™''^  -  ■"--"'  ■-'-"^  '^  -  "^  -^^  ^t 

Mas.,age  should  be  avoided  in  certain  skin  affections,  as  eczema 
act^e,  and  other  skin  eruptions,  in  wounds,  bums,  and  ery^-X' 
m  tumors  and  purulent  inflammations,  and  in  acute  diseZ  rf  he 
bone  t,s.sue.  It  should  not  be  used  in  the  acute  stag^ori-  re 
cons  .tutional  or  local  diseases,  where  complete  restTncL^v 
an  ,.  should  be  allowed  only  with  great  pr'ecautiot  in  p^^' 
and  m  the  presence  of  renal  disease.  Its  place  in  the  treatment  II 
sprams,  fractures  and  other  surgical  conditions,  and  Hie 
.n^med,cme  w.U  be  considered   more  fully   i„   ,He   appropriate 


CHAPTER    IV 

EXEROSE  BY  APPARATUS 

The  application  of  exercise  and  massage  by  mechanical  means 
has  been  considered  from  two  points  of  view-firstly,  from  the 


Fig.  jj.— The  pdymarhjiioil  of   Caolain  rh,'~..      A  ■ 

standpoint  of  the  physical  educator,  who  kouW  obtain  rapid  ..evel- 
opmentof  the  entire  muscular  system  by  specially  designed  ap- 


EXERaSE   BY  APPAHATtrs 

lecreased  for  frequent   rapi.lly  repeated  motions;    hTlZ^ 
nor  res,s.ance  is  necessary;    weight  must  be    lifted  ormoved 
■f  the  best  qua hfes  of  the  muscle  are  to  be  developed 

Many  so-caUed  free  exercises,  such 
as  deep  knee-bending,  use  the  body 
weight  for  resistance. 

Dumb-!,ell3  have  been  used   since 

the  time  of  the  Greeks  for  the  purpose 
of  shortening  the  period  required  to  de- 
velop a  muscular  group.  Their  appli- 
cation ,s  crude  and  limited,  however 
m  comparison  to  the  accuracy  and  ver- 
satility of  machines  employing  the  prin- 
ciple of  the  lever  or  the  pulley  weight. 
Jhe  direction  of  a  dumb-bell's  pull  is 

always   downward,   whereas,   with   the 

shoulder    attachment     of    the    puUey- 

weight,  the  drag  is  lateral,  and  the  high 

attachment  of  the  pulley  reverses  the 

direction  of  the  force  of  gravty.     By 

changing  the  position  of  the  pulley  it  is 

thus  possible  to  isolate  the  action  of  all 

the  important  muscle  groups. 

We  have  records  of  Captain  Chiosso,  as  early  as  iS,n  .»        u 

^rt:;-ir:;^>---'-.r=::i:r^ 

.mpor.  haUtma    with     '"T  '"'"i'"'  '"'  '"'  ''^'"^  "'  ^  "«'« 

and  its  heaut7,;  ".!"';  ^  '='"P'°^"'  •"  "''  -binary  room  "- 

heauty  „f  hne,    the  elegant  and  ornamental  structure  of  the 


Fig.  J6.-Dr.  Sargent's  first 
design  for  the  pulley-weight, 
mlh  adjusuble  weighu  in 
wooden  boxes. 


58 


EXERCISE  IN   EDUCATION  AND  MEDICINE 


whole  fits  it  for  a  prominent  position  in  the  dining-room,  library, 
or  boudoir." 

In  spite  of  these  advantages  it  did  not  make  a  permanent 
impression  as  an  exerciser,  an  article  of  furniture,  or  as  a  means  of 
p-  -  _     treating  the  dozen  maladies  for  which  it 

rV  ^  was  claimed  to  be  most  beneficial. 

Other  machines,  designed  on  this  prin- 
ciple, have  been  constructed  and  used  for 
the  last  fifty  years,  but  the  improvement  of 
their'  design,  their  systematic  application 
to  gymnastic  training,  and  their  wide  em- 
ployment in  physical  education  are  un- 
doubtedly due  to  the  efforts  of  Dr.  Dudley 
A.  Sargent,  of  Harvard,  who  has  perfected 
the  numerous  developing  appliances  that 
are  known  by  his  name,  and  every  gym- 
nasium is  now  supplied  with  a  more  or  less 
complete  set. 

In  its  simplest  form,  the  pulley-weight 

shows  one  pulley  attached  to  the  wall  at 

the  shoulder  level,  over  which  runs  a  rope 

with  a  handle  at  one  end.    The  other  end 

of  the  rope  is  fastened  to  a  weight  carrier, 

steadied  by  guiding  rods,  which  may  be 

loaded  with  iron  plates    (Fig.  27).      This 

rope  may  be  compounded    by  means  of 

another    pulley   attached    to    the    weight 

carrier,  so  that  its  excursion  is  half  that  of 

the  arm  (Fig.  28,  A). 

In  this  way  the  height  to  which  the  weight  is  lifted  is  halved, 

allowing  twice  the  range  of  movement  with  the  same  length  of 

guiding  rod. 

A  further  elaboration  of  the  pulley-weight  uses  a  floor  attach- 
ment, the  rope  turning  about  the  pulley  at  the  level  of  the  floor, 
making  a  downward  resistance  (Fig.  28,  B). 

A  third    variation,  called  the    intercostal  attachment,    uses 


F^'K-  '7- — Thepcrferted 
pulley-weight  machine 
(Narragansett  Co.),  with 
weights  attached  by  mov- 
ing a  foot  lever.    Single. 


EXERCISE   BY  APPARATUS 

the  overhead  puUey,  which  draws  the  arms  upward  (Fig  28  C) 


Fie.  .8.-Triplf,  pullej-.riKhl  (Narragaiuoll  Co) 


o.   me  neck  may  be  developed;  also  for  the  foot,  to  exercise  the 
muscles  of  the  leg  and  thigh.  e^rcise  the 

The  quarter-circle  is  a  modification  of  the  regular  pulley-weight 


6o 


EXERCISE    IN    EDUCATION   AND    MEDICINE 


machine   for  keeping  the   trunk  overextended  during  the  arm 
movements.  * 

Pulley-weight  machines  have  been  designed  by  Dr.  Sargent 
for  strengthening  the  flexors  of  the  fingers  (Fig.  30),  and  for  the 
pronation  and  supination  of  the  forearm. 


-Quarlcr-cirtie  (Si>alding). 


Others  are  used  for  practising  the  movements  of  pushing  down- 
ward on  the  parallel  bars  (Fig.  ,:)  and  chim>ing  the  horizontal  bar 
In  these  machmes,  the  bars  are  set  on  sliding  rods  and  balanced 
by  counter-,ve,ghts,  while  the  resistance  may  be  increased  with 
the  strength  of  the  user.     They  are  designed  for  the  man  who  is 


EXERCISE   BY  APPARATUS 


6l 


Fis.  30.-l-i„|(er  marhini-  to  develop  floors  „f  Ihc  lingers  and 


Sraapins  [loviiT  (Sialding). 


Fig.  ^..-Traveling  ,„„„«  (Narraganse..  Co.),  invented. by  D.  A.  Sargen,  tord.ve.o,. 
ing  purposes. 


EXERCISE  IN  EDLCATION   AND  MEDICINE 


62 

z^Jt '"  ™T  K  ""^  "'"^'^  "'^^''^^  °"  '"^  P"""^'  ''"d  hori- 
zontal bars,  and  by  their  assistance,  he  is  enabled  to  develop 
gradually  strength  sufficient  for  the  usual  feats 

shown  •!"^'"-°"'  "PP"^''"'"'  °f  'he  pulley-weight   principle  is 
sho«n  m  an  mvenfon  by  George  E.  Goldie,  in  which  the  body- 
we,ght  replaces  the  conventional  iron  plates.    The  gymnast  lies 
upon  a  padded  table  running  on  a  sliding  frame.    Four  handle 
are  attached  to  cords,  a,  the  top  and  bottom,  so  that  resistanc: 

I 


may  be  obtained  from  above  or  below.  The  upper  end  of  the 
frame  ,s  ra.sed  and  hooked  over  the  rung  of  a  ladder,  fixed  to  h 
wall.  Ten.s,on  on  any  of  the  handles  draws  the  table  up  the  inclined 
frame,  so  that  the  body-weight  is  the  resistant  force  Thisr  "sN 
ance  may  be  made  as  shght  as  desired  by  having  the  frame  attached 
o  the  lowest  rung,  and  may  be  rapidly  augmented  by  increasing 

omb?  '  :  'r"""    ""^''^  ''"  ""=  ^'"Sle  movements  ani 

combmafons  of  the  pulley-weight  machines  mav   be  obtained 
^  the  use  of  the  upper  or  lower  pair  of  handles  alternately  or 


EXERCISE   BY   APPARATUS 


63 


duced.     They  n.ecl  but  Imle  coordination,  and  may  be  repeated 

■'  mdel.nitely   without   great    mental 

exhaustion.  The  repeated  con- 
tracting and  relaxing  pumps  the 
blood  through  the  muscles,  which 
rapidly  increase  in  size,  but  if  the 
entire  muscular  system  be  developed 
to  Its  physiologic  limit,  a  very  con- 
siderable drain   on   the   vitality   is 


•^'K-  .1.1-— Exlreme  muscular  dc- 
vi-lopmfni  wilhoui  a  rarTO|»ndinK 
"imase  i„  hran  and  lun,,  |„„.<.r. 
Iki»    man   could    n„i    float    i„    sea 

«alcr  and  did   prcmalurclv.  „,   ,        _,   — 

.  f^*  "  -The  naui.cal  wheel  in  action, 

'vMhou    ac."n  7"  '"''-\''--  Powerful  muscular  development 

ci    s  s  ou,    t™'  r  "     T'  """■°"  '^'«-  ^3)-     These'exer- 

end^rance  '  """"'"'''  "''"'  °"'^-  -l"-"^  ^X'"  and 

The  simplicity  ot  the  movements  is  such  that  they  are  easily 


64  EXERCISE   XX   EDICATIOX  AND   MEDICINE 

mastered,  and  the  interest  in  them  soon  flags.  It  needs  a  slronK 
determination,  buoyed  with  the  hope  of  increased  strength,  tc 
continue  their  use.  In  order  >  help  the  imagination,  as  well  as 
to  form  a  preliminary  training  for  special  sports,  apparatus  has 
been  designed  to  imitate  the  movements  of  paddling,  rowing, 
sculling,  and  bicycling,  using  the  principle  of  the  pulley-weight  or 
lever.  Others  employ  friction  to  give  resistance  to  the  stroke  of 
the  oar  or  the  turn  of  the  wheel  (Fig.  34). 

In  the  inomotor  Dr.  ^argent  has  devised  a  machine  capable 
of  developing  all  the  muscular  system,  while  allowing  the  exclusive 
use  of  selected  muscle  groups.  For  this  purpose  he  uses  the  prin- 
ciple of  the  lever  as  applied  to  rowing  and  bicycling.     The  machine 


-The  Sargent  inomotor. 


consists  of  a  pair  of  levers,  connected,  Ijy  four  adjustable  rods, 
to  a  sliding  seat  and  foot-rest,  which  are,  in  turn,  joined  by  rods 
to  a  clutch  gear  or  sprocket  wheel. 

In  the  diagram  A-B  is  the  framework  of  steel  tubing.  i.the 
hand  lever  pivoted  at  P,  F  the  traveling  foot-rest  running  on  the 
track,  Pt;  S,  the  traveling  seat,  moving  on  the  track.  Si.  II'  is  the 
gear  or  sprocket  wheel,  connected  to  foot-rest  and  seat  by  rods 
FPR  and  SPR.  The  hand  lever  is  connected  with  the  foot-rest 
by  rod  C,  and  with  the  seat  frame  by  rod  D.  The  other  imiwrtant 
parts  are  the  toe  straps,  T.t.  and  seat  back,  SA. 

.\ftcr  taking  his  seat,  the  operator  grasps  the  handles  and  pulls. 
As  he  braces  his  feet  the  foot-rest  moves  forward,  turning  the 
wheel  W.    M  the  same  time  the  scat  is  forced  backward  by 


EXERCISK    BY    APPARATl'S  (,. 

Straightening  the  thighs,  ami  al.so  serves  to  turn  the  wheel  through 
..s  connectmg  ro,l,  SPR.  When  extension  is  compIete.T  e  s^^^n, 
half  of  the  movement  begins,  and  the  wheel  is  .u'me,  l.ysh^^ng 
anoh  ':''"f^''"<^  P""'""«  'h"  'oot-rest  and  seat  toward  one 
anoher  by  flexmg  the  legs.  The  ,«wer  thus  obtained  mav  L 
apphed  to  large  flywheels,  as  in  the  illustration  (Fig.  36)  oTth^' 
machme  may  be  mounted  on  -oilers  geared  down  ^' tha  i 
moves  only  a  few  inches  for  every  stroke.  In  this  way  th'imere 
of  a  long  race  may  be  obtained  in  a  small  room.    The  k'-  "      r 


TiK.  36.— The  Sargrnt  inomolor  with  flywhcrl 


obtamed.     The   general   exercise  is  always  sufficiently  active  to 
give  valuable  training  for  the  heart  and  lungs 

It  B  capable  of  infinite  variety  in  its  construction  and  applica- 

Tans  or"  r,'-''''''"''^  T'  °'  ""■^'^P'""  ^"'--'-'  «-- 
means  tor  propulsion  on  land  or  water. 


I 


66 


EXEICUE  IN  EDUCATION  AND  MEDICINE 


The  use  of  mechanical  means  for  the  treatment  of  disease  was 
first  systematized  and  employed  in  a  complete  way  by  Dr.  GusUve 
Zander,  of  Stockholm,  about  1857.  He  there  esUblished  and 
directed  the  first  Zander  institute,  and  has  been  actively  engaged 
in  the  practice  of  medicomechanical  gymnastics,  lecturing  on  the 
subject  at  the  medical  school  of  Stockholm  until  his  recent 
retiremcn;,  when  he  was  succeeded  by  his  eldest  son. 

Zander  has  devised 
;  nearly  one  hundred  ma- 
chines to  give  his  exercises 
and  manipulations,  and  his 
system  of  mechanotherapy 
has  enjoyed  a  wide  popu- 
larity in  Europe,  and  has  a 
considerable,  following  in 
I  America.  Zander  institutes 
are  found  in  Boston,  Balti- 
more, Philadelphia,  St. 
Louis,  San  Francisco,  and 
elsewhere,  while  over 
seventy  sanatoria  are  sup- 
plied with  some  of  his 
apparatus.  The  machines 
are  in  three  series; 

First  Series. — Apparatus 
set  in  motion  by  the  mus- 
cular power  of  the  patient. 
Second  5fr».j.— .Apparatus  set  in  motion  by  means  of  some 
motor. 

Third  ^frifj.— .\pparatus  exercising,  by  the  weight  of  the 
patient's  body  or  by  mechanical  arrangements,  a  cmective  pressure 
or  tension.  They  are  classified,  according  to  their  physiologic 
effects,  into  four  sections: 

1.  Apparatus /or  Active  Movements.— To  exercise  and  develop 
—(a)  Arms;  (b)  legs;  (c)  trunk,  and  (</)  balance.  These  machines 
are  38  in  number.     A  typical  example  is  Fig.  37,  for  forearm 


F>8-  j;.— Machine  for  Sexion  and  extf 
the  foieamu. 


EXERCISE  BV  AWA«ATM  ^ 

flexion.    Its  action  may  be  rcvcruvi  -.,  i        ■ 

extension.     A  nun,™  of  o7h  u    "*''  '°  '"^''»«  '"'""n 

~en.  i,  ,Ven  the  .at  ,y  ^otor  ,»,S;;  J  jj;:^,  "^ 


:*:  :ir^-  --  -  <"'  "><=  ™-'es  o^  .„«  ,oi„s  a„d 

elevation.  ThT  ma:hine  L  '^e  ^di  i:";'  ™'"'™'  ^"'  ^^'"^ 
passing  notice.  It  is  call^  .h!  ^^  ^'°"  "^'■"^  ""^e  than 
n.oven.ent  is  perfo™Jl^..f  „,^-;;  (^■■«-  38).  and  the 
beneath  the  a^-pit,  and  L..^:tt'^^X::i^2 


« 


EXUCIRE  IN  EDt'CATIUN  AND  HEPICINE 


chest  is  thrust  fomard  rhythmjcally  by  a  cushion  appliwl  against 
the  back  of  the  patient,  as  shown  in  the  illustration.  The  rate  is 
set  to  correspond  with  normal  respiration,  and  the  thoracic  walls 
are  expanded  and  stretched  by  its  use. 

3-  Apparatus  for  Mnhanieal  Operalions,  including  Vibra- 
lum,  Perrussion,  Kneading,  and  fw/ifw.— Vibration  is  ({ivcn  to 
the  whole  body  by  the  jolting  movement  of  a  saddle-shaped  seat 


Fig.  30.— The  "hone,"  lo  give  vibnuion  of  Ihc  whole  liody  (ijllinK  laddlewayj,). 


(fig-  39).  and  the  Zander  vibrator  is  adjusted  to  give  about 
500  strokes  a  minute  to  the  feet,  legs,  chest,  or  abdomen. 

Four  machines  are  devoted  to  percussion:  Fig.  40  is  pro- 
vided with  four  beaters  for  tapotement  along  the  spine.  This 
machine  has  been  called  the  "digitalis  of  the  medical  gymnast," 
from  its  action  in  slowing  the  heart-beat. 

One  machine  is  devoted  to  kneading  the  abdomen  and  six 
to  friction  of  the  arm,  fingers,  leg,  foot,  back,  and  abdomen. 

4.  The  orlhopedir  apparaitts  are  eleven  in  numbw,  and  are 
designed  for  suspension,  rotation,  and  lateral  pressure. 


EXEICISr.   BY  APPAIATl'S 


69 


A  comiJete  ou.fi,  require,  a.  Ie.„  3000  square  feet  of  ,,„cc, 

The  resistance  is  .,u,,pli«l  by  a  weight  an.l  lever  instead  of  a 
pulley-weiKht  m  all  the  machines  re.,uirinK  vo|untar>-  action  from 
l^iJr,  T  "".'*  a"«ment«l  by  moving  and  damping  the 

«e,ght  at  any  pomt  of  the  graduated  scale  market  on  the  lever. 


Fi«.  40.— Zander's  hark  pcrcussor. 

c™17  ""^u^'f  '"  '""P'^  "■'■"'  ^'-"•"""'^  '"«•  "f  -"Uvular 
rit  "'k,  "'  ''''"  """  ""•'  '""-^'"S  -"'action  the 
muscle  ,s  able  to  accomplish  less  work.  The  resistance  is  then 
nude  o  d,mm.h  during  the  latter  half  of  the  movement,  a  princip  e 
rS  r  ''I'^^'ru^^  -•^•--e  is  furnished  bvfrictio!: 
of  th.;  :      "  "'^  "^^'"^  '"'  developing  flexor  power 

of  the  leg  upon  the  thigh  the  greatest  resistance  occurs  wheTthe 


TO  •  ExransE  js  EDPCAnoN  and  medicine 

5i™!^"'  '!;?"'  '°  'T"'  '""^  '""P'""  «'--■"».  «"'^  being 
esfmated  as  the  pomt  of  greatest  power  in  the  knee  flexors. 

ove  come  by  employing  these  machines;  the  amount  of  relSLce 
■s  always  constant,  and  can  be  diminished  or  increased  as  defred 
accordmg  to  the  strength  of  the  patient.  ThTdose  trt 
accurately  prescribed,  and  the  uncerLnty  of  the  humaaTand 

can  be  eliminated.    The  pmount  of  resistance  forms  a  curve,  the 


Fig.  41— The  Z«nder  vibnitor. 


apex  of  which  is  at  the  point  of  greatest  physiologic  efficiency 
^^rt^^X^.  "-''«-•"  ''^  -■--  -"  'He  var^g 

(rf^r""^'  "'  '™''"  '^'^'""^  ^""^  ''^*''«"«'  by  C.  F.  Taylor 

1869),  and  numerous  modifications  have  been  made  to  simphfy 

the  somewhat  cumbersome  mechanism  of  the  originals.         ^^ 

rhe  Zander  vibrator  gives  a  rate  of  from  500  to  900  strokes 

rocL^o— '  sir  '"^"' "-'-  -"^  '^^  -«^  ^-'^^^ 

There  are  three  types  of  vibrator  now  in  use:   the  rigid  arm 
vibrator,  of  which  the  Zander  machine  is  an  e.^mplc;  th"Yex^" 


EXEKCISE   BY  APPARATUS  j, 

S  pLT"' "' "" '"""'"' '"'""°'' '""'""''' '" ""  '='«'™- 

lenlT*,  T""'"^  'u°"'''  '''  '''"'"'y  '"'J"^"''"e  i"  rate  and 

much  hT  1"'k'"Tu"-  ^'"=  ^"«'''  °f  '"«  ^'brator  has  beea 
much  discussed  but  Eberhart,  of  Chicago,  happily  compares  them 
o  various  sized  hammers:  "  If  one  wishes  to  drive  a  smaTl  naT 
he  could  do  so  with  either  a  sledge  hammer,  an  ordinaiy  hamTer 
or  a  tack  hammer.     The    ledge  hammer  would  driv^it  aT^ne 

h  m'mer  ^h'/"""  ''  '""•^''  ^P^^"""-  P°-^;  '"e  ordina" 
hammer  would  drive  it  in  four  or  five  ..rokes;  the  tack  hammed 
would  po^.yy  require  a  do«n  blows.  The  fi^al  result  w. uTd  be 
the  driving  of  the  nail." 

Mechanotherapy  has  obtained  its  greatest  hold  in  .America 
through  the  vibratory  treatment.  The  power  of  properly  appM 
vbraton.  movements  to  quiet  pain,  to  make  a  rapid  and  excH 
heart  beat  ^ow  and  steady,  and  to  reach,  through  the  sp^ 
nerves,  the  deep-seated  organs  presided  over  by  the  symL  het 
nervous  system,  is  well  established.  5ymp8.hetic 

Three  points  must  be  carefully  considered  in  the  app/ication 
of  this  treatment:  ^z)  The  length  of  the  stroke;   (,)  its  rate     (^) 

limite,  and  modified  in  their  effects  by  the  applicator  us^  the 
bril^'t^rr  'r  "  -"^-g^^d  machine' being  a  rub^ 
.hTthr:.^d  ,  =^2  T""'  '""'  ^  ^'""'  ''''  °f  -"'rubber  fc 
fh-it  Tk  1 1  ^"^^  ""'^'^  "^''''  ''■■''=  'he  erector  spin^- 
a  hollow  rubber  ball  for  the  treatment  of  the  eye;  a  flat  dfsc  a 
v^uum  cup,  and  special  vibratodes  of  hard  and  ^.ft  rub^r  for 

wTon      r™-     ""■"=  '""^  ^''""■'^^  ^-  P'-te'™.  ■■"  his    ime 

W  Stimuli;       7>  I™"''"""'  ^'''"''''"  ""=  "-^-^"'^   'n'o 
(I)  Stimulation;  W  vibratory  stimulation;  and  (3)  vibration. 

St  mulation  is  produced  by  a  milium  stroke  and  light  pressure, 

wuhth    brush  attachment,  for  increasing  the  bloo/supply  to  a 

ulation.  ^  application  should  last  from  three  to  seven  seconds. 
Vibratory  stimulation  is  applied  by  the  rubber  ball  with  a 


71 


EX£KCIS£   IN  EDUCATION  AND  llEDICINE 


medmm  stroke  and  deep  pressure,  the  treatment  lasting  from  eight 
to  twelve  seconds  over  one  spot.  This  is  recommended  for^ 
m  wh,ch  the  viscera  are  to  be  reached  by  acting  on  the  spinal 
nerve-roots.  "^ 


uble  r„dicatt  v««,n^r  area.     SimuUHo^  ,1,     """"  ""^  ,^'"  "^  "™»  '"  *« 
.ma,.c,.h.„^„,™,.Sh,^T^:r"u'5e'V,SiSXt"dti4"^^^^^^^^ 

■.K^lu'^u°°.'"f  P"^"'"^  ^^  "  ''""■y  ^'"^^  »"d  deep  pressure 
with  the  hard-ball  attachment.  It  should  not  be  given  for  more 
than  fifteen  or  twenty  seconds,  and  is  used  to  inhibit  a  nerve  that 
■s  givmg  pam.  Pilgrim  especially  warns  operators  against  over- 
sfmulafon,  which,  while  not  permanently  harmful,  is  never 
considered  desirable. 


EXERCISE   BV  APPARATUS 

^  IS  that  all  functions  and  organs  of  the  body  are  controlled 

-r,rne^r:zr  ;r^  ■•^'^-^•- - -^ 

shows  senslfVeness  .hen  r/distlrhLeTfur  e^rj 

nerves  from  the  spinal  canal.    When  the  nerve  is  vibrated    ,hZ 
pa-nful  po.n.  tends  to  disappear,  and  coinciden^lirrrstlLn 


Fig.  41. 
icml  vibratory 
Rubber  brush; 
ment  (rubber) 


CHAPTER   V 

THE  GERMAN  SYSTEM  OF  PHYSICAL  TRAINING 

It  is  to  Germany  that  modern  physical  education  n,.,st  look 
for  one  of  the  most  powerful  influences  in  its  development,  and 
tho  somewhat  acrimonious  discussions  thnt  fill  gymnastic  litera- 
ture, between  its  supporters  and  the  foUowers  of  Ling,  the  Swede 
have  done  much  to  clarify  the  principles  on  which  the  German 
system  is  based. 

It  is  necessary  here  to  review  briefly  the  origin  and  growth 
of  German  gymnastics  and  their  introduction  to  America 

To  Basedow  belongs  the  honor  of  first  combining  physical 
and  mental  education  in  the  general  training  of  the  European 
youth  In  1774  he  founded,  at  Dessau,  the  "  Philanthropinum," 
to  realize  Rousseau's  method  of  nature,  "so  that  the  training  of 
the  mmd  and  body  shall  serve  to  assist  each  other."  He  em- 
ployed the  knightly  exercises  of  riding,  fencing,  vaulting,  and 
dancing  in  educating  the  sons  of  the  burghers.  He  also  drew 
h.s  exercises  from  popular  German  sports,  rowing,  swimming 
skating,  and  games  of  ball,  and  copied  from  the  gymnastics 
of  the  Greeks,  notably  the  "  Pentathlcn, "  which  consisted  of 
weThte'    ^'""'''"^'    ^'™'"'''^'    ^^^^^^'    *"<*    '^"y'"'S   heavy 

Among  his  disciples  were  Salzman  and  Guts-Muths,  lahn  and 
Spiess  m  Germiny,  Pestalozzi  and  Fellenberg  in  Switzerland 
Nachtegall  m  Denmark,  and  Ling  in  Sweden. 

Salzme^i,  one  of  Basedow's  assistants  at  Deaau,  established  a 
school  .t  Sch»epfenthal,  near  Gotha,  in  :jS^,  and  here  Guts- 
Muths  received  his  inspiration.     As  he  himself  writes: 

"I  entered,  when  still  a  youth,  the  school  of  Schnepfoithal 


THE  OM«AN  SYSTEM  OF   PHYSICAL   GAINING 


75 


He  afterward  wr^lwl  on  1        T  """"'"  "'g^'™-'-. 

ain,s,whfchmaybesta(^Thr    ^"'^-^""'^  '""^  '«■"  distinct 
*iia^  uc  siaieq  m  his  own  worHs  ns *<  /^x  nr    i   . 

Fr;»H-;,k  T    J    .     T  ,  P    '  ™  '"^  second. 

W  He  wa:;"!/''"  ™^  ""^  '■"  '"8,  in  the  village  of 
d.-spositio„   Zcl  T^J  3--.  .-"ess,  and  .If-sufficient 

career  as  a  student  rswHdandT'J'T"  'V"  ™*'"«-  «'^ 
with  the  n,en,ber.  of^i  „'  Sl^'  rHaTl  '"J"''"'^ 
wanderer  from  university  to  unive^^  Fertile  K^"'  ' 
Jena,  where  he  was  forced  to  leavlt;^  ^^  ''^"'  *° 

private  tutor   direrti„rv  .  ,  ""■^rsity  and  become  a 

appeared  in  i8oo  Ld  sS  h      ""t.  P™"°"°"  °f  patriotism, 
agS.    For^Le  next  tin  V      ^       '  '"  '"'"«"  '"  '"P"'" 


76 


EXEKCISE   IN   KUUCATIUN   AND   MEDICINE 


word 


siwcial   costumes   were  adopted.    Their  badge   liore   the 
"Turnkunst,"  and  the  figures  "9-919-1519-1811  " 

/.■• 

TumkiKist       . 
\      'S">      , 

These  figures  served  as  reminders  of  Hermann's  rout  of  the 
Roman  legions,  under  Varus,  9  a.  d.,  the  introduction  of  tourna- 
ments into  Germany,  919  A.  D.,  the  last  of  the  German  tourna- 
ments, 1519  A.  D.,  and  the  revival  of  "Turnen,"  or  turning  in 
1811. 

In  a  year  the  number  of  turners  rose  to  5C0.  Jahn  and  Friesen 
organized  a  German  union,  hostile  to  all  foreign  rulers,  and  ex- 
tended it  to  the  students  of  various  German  universities.  In  the 
war  of  liberation  members  of  this  union  were  the  first  men  enrolled 
in  the  famous  free  corps  of  cavalry,  where  Jahn  commanded  a 
company  recruited  by  himself. 

In  the  five  years  preceding  1816  he  latjorcd  incessantly,  writing 
and  publishing  his  book,  "Die  deutschc  Turnkunst,"  which  sums 
up  his  aims  and  accomplishment.  In  speaking  of  the  beginning 
of  his  work  he  says:  "  Love  to  my  fatherland  and  my  own  inclina- 
tions made  me  a  teacher  of  youth.  During  the  beautiful  spring 
of  i8io  a  few  of  my  pupils  began  to  go  out  with  me  into  the  woods 
and  fields  on  the  holiday  afternoon  of  Wednesday  and  Saturday. 
The  number  increased  at  the  various  sports  and  exercises.  Thus 
we  went  on  until  the  dog-days,  when  the  number  was  very  large, 
but  soon  fell  off  again.  But  there  was  left  a  select  number  and 
nucleus  who  held  together  even  during  the  winter,  with  whom  the 
first  turning  ground  was  opened  in  the  spring  of  i8n  in  the 
Hasenheide." 

In  this  work  he  pays  willing  tribute  to  Guts-Muths,  the  main 
source  of  his  inspiration. 

In  1819  plans  were  perfected  for  establishing  turniilg  grounds 
throughout  Prussia  in  connection  with  the  schools,  but  because 


THE   GERMAN   SYSTEM   OF   PHYSICAL   TRAININC.  77 

Of  a  murder  committ«l  by  one  of  the  turners,  to  which  ,K,litical 
significance  was  attachecl,  the  student  societies  and  Turnverein 
were  put  under  the  ban  as  being  hot-beds  of  liberalism.  Jahn 
was  arrested,  as  well  as  Francis  Lieber,  a  youth  of  nineteen,  one 
of  h.s  oldest  and  most  favorite  pupils.  Lieber  was  exiled,  and 
chose  the  tnited  States  for  his  new  home  in  1827.  He  came  with 
a  recommendation  from  Jahn  for  the  express  purpose  of  taking 
charge  of  a  gymnasium  in  Boston,  where  he  also  established  a 
swimmmg  school. 


Fig-  44. 


-IVo|,le  throwing  flower,  lo  Ihf  Amerieaa  Turners  at  Ihrpara'c  whTTT" 
the  Tumfesl  of  .goK,  in  Friinkforl. 


Jahn's  case  dragged  on  for  nearly  six  years,  but  he  was  acquitted 
m  1825,  although  with  certain  restrictions.  In  1840  he  was  finally 
released  and  awarded  the  iron  cross  in  recognition  of  his  service 
durmg  the  war  of  liberation.  Though  he  issued  many  pamphlets 
showmg  his  continued  interest  in  turning,  his  declining  years  were 
passed  m  poverty  and  obscurity.  His  last  publication  appeared  in 
1848  entiUed  "Schwanenrede"  (swan  song),  closing  with  these 
words : 

"Germany's  unity  was  the  dream  of  my  awakening  life,  the 


THE  GEMIAN  SYSTEM  OF  PHYSICAL  TSAININO  79 

morning  glow  of  my  youth,  the  sunshine  of  my  manhood,  and  is 
now  the  evening  star  which  guides  me  to  eternal  rest." 

The  formation  of  gymnastic  societies,  however,  continue.!  to 
grow,  and  Tumfests  were  celebrated,  until  in  i86i  nearly  6000 
turners  took  part  in  the  festivals. 

At  present  it  is  as  common  to  find  a  Tumverein  among  German 
colonists  and  peoples  of  German  e«raction  as  cricket  and  athletic 
sports  among  Englishmen  li\ing  abroad. 

The  Tumfest  at  Frankfort,  held  in  July,  1908.  had  30000 
turners  m  line,  drawn  from  every  land  to  which  there  has  been 
German  immigration.  America's  numbers  exceeded  that  of  any 
nation  outside  of  Germany.  The  hold  of  turning  upon  the  German 
people  was  evident  by  the  enthusiasm  displayed  during  the  parade 
of  the  visiting  turners  on  the  opening  day.  Flowers  and  wreaths 
were  showered  upon  them  by  the  spectators  along  the  route 

The  exercises,  which  continued  for  six  days,  opened  by  a 
mass  dnll  of  about  20,000  men.  The  illustration  shows  about 
Sooo  men  rehearsing  for  this  event.  Although  all  the  societies 
drawn  from  distant  lands,  had  never  performed  together  before 
the  exhibitions  were  faulUess.  On  succeeding  days  group  com- 
petitions and  drills  were  given  by  children  (Fig.  46)  and  by 
picked  squads  representing  their  societies,  with  individual  and 
group  competitions  on  the  horse,  horizontal  and  parallel  bars 
running,  and  vaulting.  Prizes  in  the  form  of  wreaths  and  diplomas 
were  given  to  the  successful  societies  and  competitors. 

The  turners  place  great  emphasis  on  mass  work,  and  the  social 
side  has  not  been  neglected.  They  have  long  ceased,  however, 
to  be  political  clubs,  holding  themselves  entirely  aloof  from  the 
consideration  of  party  questions. 

They  are  divided  into  two  main  sections:  boys  from  seven 
to  sixteen  years  and  men.  Classes  are  subdivided  in  squads 
each  squad  being  led  by  a  "foretumer,"  whose  business  it  is  to 
make  the  members  of  his  squad  as  expert  as  possible,  and,  above 
aU^to  secure  to  each  an  erect  form  and  aggressive  carriage  of  the 

The  introduction  of  the   German  gymnastics  into  the  school 


8o  tXZlCISI  W  EDDCAnON  AMD  HEOlaVE 

•yrtem  was  the  work  of  A.UJph  Spies.,  a  Hessian,  born  in  1810. 
He  was  influenced  liy  Pestalozzi,  and  trained  in  the  methods  of 
Guts-Muths.  In  1829  he  became  acquainted  with  Jahn,  and  in 
the  following  year,  whHe  still  a  student,  formed  a  class  of  boys  at 
Giessen,  and  made  a  beginning  by  teaching  what  is  known  as  com- 
mon exercises,  the  simultaneous  performance  of  movements  in  re- 
sponse to  the  word  of  command,  either  with  or  without  the  aid  of 
apparatus.    He  is  sometimes  called  the  creator  of  gymnastics  for 


FiR.  <6.— A  naaa  drill  of  ichool-rhildrfn  at  the  Turnfc«t,  Franktort,  .908 


girls.  These  gymnastics  he  introduced  into  the  public  schools  of 
Burgdorf,  in  SwitzerUnd,  where  he  became  acquainted  with 
Froebel.  They  include  free  gymnastics,  dumb-bell  drills,  exer- 
cises on  the  suspended  ladder,  and  see-saw,  besides  running, 
jumping,   and    swinging. 

In  1848  he  returned  to  Germany,  and  at  Darmstadt  carried  on 
special  normal  classes  to  train  assistants  for  his  work,  until  his 
death  in  1858.  He  was  highly  successful  in  teaching  gymnastics 
to  the  girls  of  his  schools. 


THE  CE«MA.V  SYSTEM  OF  PHYSICAL  TRAININO  8l 

rjTo  r:i  •°/)'»'ema.-  German  gymnastics  and  .o  Ip. 
Uiem  to  pedagogic  purposes  and  methods.  ^ 

iTussian  army,  was  placed  at  its  hrarl      d„.u  .  • 

parti/an  of  ih^  <:,„J^  i,  Rothstcin  was  a  warm 

a^d  srrr  t  '"™"^  ''"^^-'^^^^^^^^^^^^^^ 

sy"  te,;  and  1:  K^     ..  ',  "■''°  """"^'^'^  ''^'<'"''"'    "-e   German 

pupl''  rrv"'  "'  ""'""^  "^^'"^  '"  "''=  "(Se  and  sex  of  the 

gymnastic  machines.      These  erirrr  ""  exercises  on  the 

and  difficult  fnr  J  «efciMs  grow  more  complicated 

«?yn,nastiXt^ct"n."       ^   '  '^  """"'  ^'"^^'^  ™""^-^  -"> 


82 


EXEICUE  IN  EDl-CATION  AND  HEPICINE 


Outdoor  gsmo  have  been  accorded  a  place  in  the  Gennan 
system  from  the  first,  but  interest  in  them  has  increased  to  an 
extraordinary  degree  from  the  year  idyi,  when  the  Central  Com- 
mittee (or  the  Promotion  of  Youthful  and  Popular  Sports  in 
Germany  was  organized  under  the  presidency  of  Baron  E.  von 
Schenlcendorff.  Facilities  for  school  games  have  been  provided, 
and  provision  has  also  been  made  for  their  management  and 
maintenance.  The  movement  resulting  in  the  American  Play- 
ground Association  may  be  traced  to  the  labors  of  this  committee 
and  its  distinguished  president. 
The  introduction  of  Ger- 
man gymnastics  in  .\mcrica 
Ijegan  with  the  arrival  of  Dr. 
Follen,  a  German  exile,  at 
Harvard,  in  i8j6.  The  Bos- 
ton Gymnasium  in  Washing- 
ton Gardens  seems  to  have 
been  the  first  public  gymna- 
sium of  any  note  in  the  United 
States. 

In  1837  Dr.  Francis  Lieber, 
already  referred  to,  succeeded 
Follen.  Gymnastic  grounds 
were  established  at  Yale, 
Williams,  .Amherst,  and  Brown 
about  the  same  time,  while  a 
dozen  or  more  schools  followed 
suit.  This  movement,  how- 
ever, was  short-lived,  and  closed  about  1830,  when  both  Dr. 
Follen  and  Lieber  left  the  field  and  followed  other  pursuits. 

The  subsequent  history  of  German  gymnastics  in  America  is 
that  of  the  growth  of  German  immigration  and  the  establishment 
of  the  Tumgemeinden  in  large  American  cities,  such  as  St.  Louis, 
Milwaukee,  Philadelphia,  and  Cincinnati.  The  Xormal  College 
of  the  North  American  Gymnastic  Union,  established  in  1861, 
and  now  conducted    at    Indianapolis,    is   employing   educated 


FiR-  47. — Typical  pair  En  Orrman  wand  drill. 


THF.  OK.MAN  SYsrrll  OF  PHYSICAL  TKAINLNO  83 

teacher,  «aine.l  in  ,hi.  „.,„.„,  by  „„^  „,^„,,i 
four  yca«   and  ,he  official  orsan  of  the  movemen,,  a  monthly 
calle.    ".Mm,,  and   B.-l,,"  earric.  on  an  active   can„»iKn  ,0 
mtro.  uee  physical  traininR  into  the  school  system,  ami  dis'.minate 
knowledge  on  the  subject. 

William  \.  Stecher.  its  editor  and  director  of  ,.hy.  i, ., , ,, ,  ,„  f  .'nn 
m  the  school.,  of  Philadelphia,  divides  the  German  m  h  ,  ,„.  siv 
lar|{c  groups  or  classes: 


Fin.  ,K 


-Typicnl  .wing  and  b.-,l«„co  „„ciV  on  ,hr  p,r.-ill<.|  !»„. 


1.  Tactics,  embracing  marching  in  all  its  forms 

2.  Free  exercises,  embracing  all  forms  with  hand  apparatus, 
hke  short  and  long  wands,  dumb-bells,  rings,  and  clubs 

3.  Dancing  steps,  principally  for  girls,  including  all  the  move- 
ments from  the  simple  gallop  to  the  most  complicated  forms 
executed  by  expert  dancers. 

4.  Apparatus  work  on  the  horizontal  bar,  parallel  bars,  long 


a, 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


and  side  horse,  buck,  suspended  rings,  ladder,  jjoles,  roijc,  round 
swing,  sec-saw,  balance  board,  swinging  board,  pulley-weights, 
storming  board,  and  vaulting  table. 

5.  Track  and  field  work,  such  as  high,  broad,  and  deep  jump- 
ing, hop,  step,  and  jump,  running,  hopping,  putting  the  shot  or 
stone,  throwing  the  javelinordiscus,  lifting  and  putting  up  of  iron 
weights  and  stones,  pole-vaulting,  swimming,  skating,  fencing, 
boxing,  wrestling,  and  shooting. 

6.  Games  and  plays,  the  enumeration  of  wiiich  would  take 
too  long.  The  first  collection  of  games  was  published  by  Guts- 
Muths  in  1793. 


The  exercises  for  children  are  divided  into  six  or  eight  grades, 
to  correspond  with  the  number  of  years  in  the  common  or  grammar 
schools. 

Inclusive  as  it  is  of  almost  all  forms  of  indoor  and  outdoor 
activity,  the  characteristic  apparatus  that  will  always  be  asso- 
ciated with  German  gymnastics,  because  invented  and  most 
largely  used  by  them,  are  the  parallel  bars,  where  the  typical  exer- 
cises are  those  in  which  the  weight  is  supported  by  the  arms  in 
\-aulting  and  balancing.  The  horhonlal  bar.  the  glorified  liml)  of 
a  tree,  in  which  the  weight  is  also  supported  hy  the  arms  in  circles 


THE   GERJIAX   SYSTEM  OF   PHYSICAL  TRAINING  85 

and  levers;  ami  the  z^aMng  horse,  borrowed  from  the  days  of 
ch,valry,  on  which  circles,  vaults,  and  pirouettes  are  practised 
and  carr.«l  to  a  high  ,»int  of  development,  the  weight  being 
again  supported  by  the  arms. 

Exercise  on  these  machines  emphasizes  the  development  of 

he  muscles  of  the  shoulder-girdle  by  the  almost  constant  use  of 

he  arms  m  supporting  the  body  weight,  an,l  in  this,  together  with 

the  large  use  of  music  to  govern  the  rate  and  rhythm  of  the  free 


exerc,s.-s  clone  in  classes,  lies  the  main  .lilTerence  between  the 
gymnastics  that  are  krown  as  "German"  and  those  derived  from 
other  sources.  Singing  and  turning  are  inseparable,  especially 
"■■th  the  children,  and  the  system  has  become  more  cosmopolitan 
of  ate  years  to  fit  the  local  conditions  an.l  national  temperament 
m  Amenca  They  now  may  be  sai.l  to  include  everything  except 
he  medical  application  of  exercise  and  massage,  which -has  been 
left  entirely  in  the  hands  of  the  Swedes. 


i  mi 

ill 


CHAPTER   VI 
THE  SWEDISH  SYSTEM  OF  GYMNASTICS 

The  Swedish  system  of  gymnastics  had  its  first  impulse  from 
patriotism,  as  was  the  case  with  the  German,  but  in  the  hands 
of  its  scholarly  founder  it  became  much  more  finished  as  a  gym- 
nastic system,  and  comprises  recreative  and  school  gymnastics, 
military  gymnastics,  and,  rhost  distinctive  of  all,  medical  gym- 
nastics, or  the  application  of  movement  to  the  treatment  of  disease. 

Peter  Henry  Ling,  its  founder,  was  born  in  1776,  two  years 
before  the  birth  of  Jahn,  in  Smjland,  one  of  the  southern  provinces 
of  Sweden.  A  dreamy,  imaginative  boy,  he  entered  the  Latin 
school  at  Wexio,  where  he  distinguished  himself  in  his  classical 
course  by  his  mental  ability,  strong  individuality,  unyielding  will, 
ani  reckless  enterprise.  He  was  suspended  or  expelled  from  this 
school,  along  with  some  companions,  on  account  of  a  breach  of 
discipline.  Leaving  Wexio  on  foot,  he  seems  to  have  wandered 
for  some  years  in  Sweden,  Denmark,  Germany,  France,  and  even 
England,  acquiring  the  languages  of  the  countries  in  which  he 
sojourned,  and  we  find  him,  in  1801,  enrolled  as  a  volunteer  in 
the  naval  defense  of  Copenhagen  against  the  English.  Here  he 
remained  for  ten  years,  becoming  a  skilled  fencer  under  the 
instruction  of  Montrichard,  a  French  refugee,  from  whom  he 
obtained  a  diploma  endorsing  his  ability  to  give  instruction  in  the 
art.  While  there  he  visited  and  attended  the  gymnasium  of 
Nachtegall,  and  recognized  the  national  importance  of  the  new- 
art,  striving  to  classify  and  develop  its  practice  according  to  ana- 
tomic laws  md  to  give  it  the  precision  of  mathematics. 

In  the  fall  of  1804  he  returned  to  Sweden,  to  act  as  a  sub- 
stitute for  the  aged  fencing  master  of  the  University  of  Lund, 
whom  he  soon  succeeded.    He  also  taught  gymnastics  and  riding, 


THE  SWEDISH  SYSTEIC  OF   GYMNASTICS 


87 


and  applied  himself  diligenUy  to  the  study  of  anatomy  and 
physiology,  putting  his  conclusions  into  practice  in  the  system  of 
fencing  taught  to  his  pupils.  The  new  exercise  became  pop- 
ular, and  it  was  not  long  before  interest  in  it  and  in  his  gym- 
nastics spread  beyond  Lund.  Invitations  to  introduce  the  double 
art  were  received  from  Gothenburg,  Malmo,  and  Christianstead, 
where  he  gave  instruction  during  the  summer  vacations  in  the  arts 
of  swimming,  fencing,  the  saber,  and  gymnastics. 

The  eight  years  of  his  stay  in  Lund  were  also  fertile  in  literary 
activity,  for  it  was  then  that  he  first  began  to  know  and  love  the 
Scandinavian  mythology,  and  to  compose  patriotic  poems  in 
French,  German,  Danish,  and  Swedish.  About  this  time  he  also 
wrote  "Agned,"  a  tragedy  in  five  acts,  which  was  presented  on 
the  stage  at  Stockholm.  One  of  his  poems,  "Gyfle,"  deals  with 
the  loss  of  Finland,  which  the  Swedes  bitterly  deplored.  These 
plays  and  poems  show  the  intensity  of  his  patriotism  and  his  desire 
to  see  his  countrymen  strong  in  body  and  soul,  with  power  to  meet 
her  enemies.  Fervid  patriotism  was  the  inspiring  motive  of  his 
poems  and  his  gymnastics  alike,  though  in  the  latter  he  saw  a 
practical  means  of  restoring  the  health  as  well  as  of  developing  the 
physique  of  the  race  to  defend  the  fatherland.  During  these 
eight  years  he  thought  out  the  principles  upon  which  his  later 
work  was  based,  seeking,  first,  to  understand  the  human  body 
and  discover  its  needs,  and  then  to  select  and  apply  his  exercises 
intelligently  with  these  needs  in  view. 

He  conceived  the  idea  of  opening  in  Stockholm  a  central 
institute  based  on  the  one  already  in  operaUon  in  Denmark  for  the 
training  of  teachers  of  gymnastics  for  the  army  and  school.  He 
took  as  his  pattern  the  institute  of  Nachtegall,  in  Copenhagen. 
His  plan  was  successfully  carried  out,  and  the  school  was  opened 
in  1814,  in  the  northern  suburb,  Normaln,  on  the  site  occupied  ever 
since.  Here  he  equipped  the  necessary  rooms,  gymnasium, 
fencing  hall,  and  offices,  in  some  old  buildings  which  had  once 
belonged  to  a  cannon  factory.  By  increased  grants  from  the 
Government  he  was  soon  furnished  with  an  assistant,  and  two 
others  were  added  from  time  to  time,  until,  in  i8jo,  he  had  three. 


if 


88 


EXERCISE   IN   EDUCAnON   AND   MEDICINE 


L.ng  believed  that  gymnastics  had  a  rightful  place  in  education 
medicine,  and  national  defense,  and  almost  from  the  start  instruc- 
tion was  given  in  these  three  branches.  In  spite  of  a  good  deal 
of  jealousy  and  opposition  he  continued  to  teach  fencing  and 
gymnastics  to  the  Swedish  army,  under  the  sympathetic  encourage- 
ment of  Bernadotte,  who  afterward  reigned  as  Charles  XIV 
When  It  was  shown  that  the  French  and  Prussian  soldiers  were 
being  drilled  m  bayonet  fencing,  his  method  of  teaching  this 
exercise  was  investigated  and  chosen  in  preference  to  all  others 
and  It  became  an  established  part  of  their  regular  training 

In  1836  he  published  a  manual  of  bayonet  fencing  for  use  in 
the  army,  and  another  of  gymnastics,  in  which  he  found  it  necessary 
to  limit  the  exercises  to  simple  forms  that  required  little  or  no 
apparatus. 

He  commenced  the  development  of  medical  gymnastics  after 
the  hrst  year  of  the  Institute  in  Stocliholm,  against  bitter  opposition 
on  the  part  of  conservative  physicians. 

His  school  gymnastics  comprised  only  a  few  stretching  move- 
ments, sometimes  assisted  or  resisted  by  another  pupil,  but  with 
little  apparatus,  the  Swedish  educational  gymnastics  in  its  present 
form  being  a  comparatively  recent  growth. 

During  all  this  time  his  literary  activity  was  intense,  and  always 
m  the  realms  of  mythology  and  the  ancient  legendary  history  of 
the  Scandinavian  race.  His  literary  labors  were  rewarded  by 
membership  in  the  Swedish  .Academy,  where  he  also  received  the 
grand  prue.  The  title  of  professor  was  conferred  upon  him,  and 
he  was  decorated  with  the  Order  of  the  North  Star.  His  collected 
writings  fill  three  large  volumes,  of  which  only  about  350  pages 
have  to  do  with  gymnastics. 

From  his  first  marriage  he  had  one  sur%'iving  daughter  Jetta 
and  by  his  second  wife,  three  of  his  seven  children  became  teachers 
of  gymnastics-Hjalmar,  Hildur,  and  Wcndia,  the  first  two  at  the 
Centra  Institute.  In  ,839,  after  some  years  of  impaired  health 
he  died  and  was  succeeded  at  the  C'entral  Institute  hy  Branting 
and  Georgii,  who,  in  company  with  Dr.  Liedbeck,  one  of  his 
pupils,  and  husband  of  his  daughter  Jetta,  arranged  his  literary 


THt    SWEDISH    SYSTEM   OK   GYMNASTICS  89 

remains  for  publication.  The  year  after  his  death  they  puMished 
hK  prmcples  of  gymnastics  in  the  incomplete  and  often  frag- 
mentary form  ,n  which  he  left  them,  a  treatise  begun  as  far  back  as 
i»3i.  Th.s  book,  after  an  o,«ning  section  devoted  to  the  laws  of 
the  human  organism,  takes  up  in  order  the  principles  of  edu- 
caional  nuhta^.,  medical,  and  esth  tic  gymnastics,  and  closes 
w.th  a  few  pages  of  miscellaneous  suggestions  and  comment. 

Lmgs  system  was  constructed  in  the  light  of  the  physiology 
of  h,s  day,  wh,ch  often  sounds  fantastic  in  the  presence  of  modern 
discoveries.  H,s  physiology  with  regar.l  to  the  nature  of  life,  the 
laws  of  organic  unity.  an<l  the  relation  uf  parts  .seems  quaint  to 
modern  thmkers,  and  is  not  easily  translated  into  the  scientific 
terms  of  to-day.  His  work  relating  to  gymnastics  is.  however,  of 
a  thoroughly  practical  nature,  and  he  must  have  been  a  most 
msp,nng  teacher.  He  never  completely  expressc-d  his  scheme  of 
esthetic  gynon  .sties,  and  the  school  gymnastics  were  the  life-work 
of  his  son  Hjalmar. 

Immediately  after  his  death  Branting  was  appoint«l  director 
a  position  he  retained  for  twenty-three  years.     A  student  of  the 
largest  medical  college  in  Sweden,  a  tl,H.„t  linguist,  and  a  wide 
traveler,  he  devoted  himself  with  marked  enthusiasm  to  medical 
gymnastics  in  accordance  with  the  theories  of  his  predecessor 
and  brought  that  department  to  a  high  degree  of  perfection.     He 
msisted  that  the  beneficial  effects  of  exercises  were  due  not  alone 
to  changes  produced  in  the  muscular  system,  but  mainlv  to  the 
influence   exerted   upon   the   nerves  and   blood-vcssels-a   novel 
view  at  that  time.     He  also  wcked  out  a  terminology  which,  with 
a  few  changes,  is  still  employed  in  Sweden.     M  this  ,«riod  the 
work  of  the  institute  began  to  awaken   the  attention  of  other 
counn-ies      Two    Pru.ssian   army   oncers,    Lieutenant    Rothstein 
and  Techow,  were  sent  from  Germany  to  Stockholm  to  take  the 
regular   course   of   instruction,    and    Rothstein   afterward    wrote 
extensive  y  on  the  Ling  system.     His  connection  with  the  Berlin 
Centra.   Institute  has  already  been  alluded  to  in  the  previous 
Chapter      He  endeavored  to  mo<le!  it  on  the  pattern  of  the  .Swe    ^i^ 
school,  but  uithout  its  department  of  medical  gymnastics 


90 


EXEKCISE  IN  EOCCATION  AND  UtOICart 


Many  other  foreigners  came  for  visits  of  varying  duration^— 
physicians  especially  were  attracted,  among  them  Dr.  Matthias 
Roth,  of  London,  the  father  of  Bernard  Roth,  F.  R.  C.  S.,  wbow 
work  on  scoliosis  is  referred  to  elsewhere. 

Among  the  teachers  at  the  Central  Institute  were  Karl  August 
Georgii  (1808-81),  a  lieutoiant  in  tlie  army,  who  became  bead 
teacher  in  1839,  giving  instruction  in  anatomy  and  the  thi«e 
branches  of  practical  gymnastics.  He  puUidied  a  tieatiic  on  the 
Ling  method  of  kimsitherapy  and  i*ysical  education.  Three 
years  later  be  removed  to  London,  where  for  twenty-eight  years 
he  had  a  private  institute,  teaching  fencing  and  school  gymnastics 
in  addition  to  his  medical  wofk.  Here  he  published,  among  other 
things,  a  biographic  sketch  of  Ling,  the  "new  movement  cure," 
and  a  book  on  rational  gymnastics.  Branting's  successor  was 
Colonel  Gustave  Nyblaeus  (1816-1902),  under  whose  directorship 
the  course  was  increased  from  one  year  to  two  years,  and  practical 
gymnastics  finally  reorganized,  with  its  three  sections,  educational, 
medical,  and  military,  each  having  a  head  teacher  and  a  second 
teacher. 

John  Hartelius  (1818-96),  a  graduate  of  the  institute,  who 
afterward  com^deted  a  course  in  medicine,  took  charge  of  the 
medical  gymnastics  in  1864.  During  his  term  he  wrote,  besides 
small  manuals  on  anatomy,  physiology,  histology,  and  hygiene, 
a  larger  work  on  medical  gymnastics,  which  was  translated  widely. 
He  also  founded  and  edited  the  "Tidschrift  i  Gymnastics,"  a 
semi-annual  magazine  devoted  to  gymnastics,  contributing  many 
articles  on  his  own  and  related  subjects. 

To  Hjalmar  Frederick  Ling  (i8ao-«6)  Swedish  educational 
gynmastics  is  largely  indebted  for  its  present  form,  and  the  school 
gymnasium  for  the  nature  and  arrangements  of  the  equipment 
now  in  use.  At  first  a  pupil  of  his  father,  he  afterward  attended 
Claude  Bernard's  lectures  on  experimental  physiology  at  the  HAtel 
Dieu,  in  Paris,  and  lived  for  a  year  in  Berlin,  whither  he  went  to 
introduce  the  Swedish  method  of  medical  gymnastics.  After  his 
return  to  Stockholm,  in  1864,  he  was  assigned  the  section  of  school 
gymnastics.    His  task  was  to  devise  new  forms  of  apparatus 


THE  gWEDBW  IVITEIt  Or  OYMKMUCS  91 

adapted  to  the  need  Of  the  lEhsol,  Mri  to  SO  arrange  them  that  large 
numbers  could  exercise  at  the  same  time.  He  largely  increased 
the  number  of  useful  exercises,  and  bfougfat  them  within  the  reach 
of  ewfy  pupil.  He  is  the  angiiutor  of  the  grouping  of  cxooes 
know,  «  the  «d.y,  »der,"  wUeh  is  «,  dl«Mmstic  cf  the 
Swedish  systOB.  Familiar  with  tkt  whole  range  of  gymnastic 
hterature,  he  was  an  industrious  compiler,  and  left  behind  a  care- 
fully arranged  coUeclion  of  nearly  2000  pen  drawings  of  positions 
and  movements  used  in  gymnastics,  all  made  by  his  own  fawid 
He  died  in  1886. 

Hjahnar  Ling's  successor  was  Lar«  Mauritz  T3mgren  (1887). 
A  third  year  was  now  added  to  the  course.  His  writings  included 
a  manual  of  gymnastics  for  the  nasy  and  a  book  on  school  gym- 
nastics. The  second  teacher  in  the  section  on  school  gymnastics. 
Major  Karl  SiUow,  has  been  very  active  and  successful  in  the  work 
of  his  department,  and  has  made  further  improvements  in  the 
construction  and  arrangement  of  apparatus.  Hartelius  was 
succeeded  in  1887  by  Robert  Murray,  also  a  regularly  trained 
physician,  in  the  section  of  medical  gymnastics,  and  Colonel 
Victor  Gustave  Balck  about  the  same  time  assumed  con- 
trol of  the  section  on  military  gymnastics.  The  latter  has  been 
an  ardent  advocate  of  outdoor  and  other  sports  for  the  young, 
and  has  been  active  in  organizing  societies  for  their  cultivation,' 
ediUi^  a  series  of  a  dozen  illustrated  volumes  devoted  to  a 
description  of  their  various  forms.  He  founded,  in  1881,  the 
"Sporting  Times,"  and  has  been  the  most  enthusiastic  proiiioter 
of  those  popular  gymnastic  societies  that  have  spread  the  fame  of 
Swedish  gymnastics  to  other  countries,  accompanying  squads  of 
his  fellow-countrymen  to  exhibitions  in  Brussels,  Paris,  London 
Copenhagen,  and  Berlin.  He  was  a  member  of  the  committed 
appointed  to  prepare  the  new  hand-book  of  gymnastics  for  the 
Swedish  army  and  na\'y. 

The  Swoiish  gymnastics  were  introduced  into  the  United 
States  by  the  late  Baron  Nils  Posse  through  the  instrumentality 
of  Mrs.  Mary  Hemenway,  and  Boston  has  been  the  center  from 
which  their  mfluence  has  spread.    A  most  active  propaganda  was 


]■ 


9* 


EXERCIS..   IN   KDUCATION   AND  HEDICINE 


n 


started  by  Baron  Posse,  who  lectured  ami  wrote  widely  on  the 
subject,  and  as  a  result  the  Boston  Normal  School  of  Gymnas- 
tics was  founded  in  1889  by  Mrs.  Mary  Hemenway,  to  provide 


Fin.  51— Drill  in  Ih 


the  means  whereby  those  masters  and  submasters  who  desired  it 
might  make  a  thorough  study  of  the  Ling  system  for  the  benefit 


of  the  schools.  This  resulted  in  the  introduction  of  the  Swetiish 
system  of  gymnastics  in  the  Boston  public  schools  in  i8qo,  under 
the  direction  of  Hartwig  Nissen.    After  two  years'  service,  Baron 


THE  SWEDISH  SYSTEM  OF  CYHXAST.CS  gj 

Posse  resigne,]  and  was  succeeded  by  Clacs  Fncl.uskc,  he  him- 
sd  fou„dm«  a  normal  school,  .he  Po.,e  Gymnasium  which" 
sn«  carr,e,l  on  by  .he  Baroness  in  Bos.on.     Bo.h  schools  ,ire  a 

r-  "f  T"*  '"  *"""  ''"^'>'""'  ■--"^■■and  include  a  u  do 
range  o   subjec.s  ,„  .heir  curriculum.     By  a  recen,  arransemen 

orkof,  r:^''™  '    ""    ™'»^'^"'    "-'  "f   'he  practical 

by  I  nt  s  1;  "T"""'"  '""■  '"-■™  --'-'I-"'''.'-  "KKlined 

hL  :  ^n       7'!"''  ''""'"''"^'J-  ''>■  hi>  son.  .hede,elo|,ment 

has  closely  followcl  the  lines  marked  ou,  bv  its  ori«ina.or 


complcc  uccompnshmen..     He  classified  movements  into  irouns 

as  .hey  were  ,],rec«ed  to  .he  muscles  of  the  .runk,  head,  arm   or 

leg.  makm.  use  of  a  table  which  was  .he  forerunner  of  the  present 

■ay  s  order.       His  first  table  consists  of  three  order  movemen.. 

seventh,  an  arm  mo^ement;  eighth  and  ninth,  leg  movements- 
^.mh  attd  eleventh,  arm  movements  -  all  of  a  respiratorv  natt.rc.' 
H^-  tables  al,so  show  a  forecast  of  .he  progression  which  is  .he 
o.her  charac.eris.ic  of  .he  Swedish  svs.em. 

.„.'^'1'''T  "l"^"™"^  '-  '"i"'"*?  military  cade.s  s.ronglv  influ- 
enced .he  character  of  his  theories.    E.  M.  Hartwell  justly  obsc■r^■es 


94 


EXEHCISK   IN    EnrCATION   AM>  MEDICINE 


that  Swdish  Kymnastics  still  l*ar  witness  to  their  scmimilitaty 
orJKin.  LmK's  |wculiar  aims  are  more  completely  reflected 
ami  h,s  methods  more  fully  emlKxIicd  in  the  physical  training 
of  recru,ts  and  soldiers  than  in  any  other  department  of 
S«e<l,sh  Kvmnastics.  The  military  element  in  Sullen  has  in 
t..rn  .ser,e<l  to  add  .lignity  to  physical  training  as  a  profession, 
ami  to  raise  the  intellectual  and  social  stamling  of  gymnastic 
instructors. 

The  three  distinguishing  r»ints  ..f  the  Swalish  system  of 
educational  gymnastics  are: 


FW.  54.-The  R„j.,l  0„«,d  of  Sweden  a.  .ork  in  ,hc  g,n>n«.ium  (l-cfetore) 


1.  The  day's  order. 

2.  Gymnastic  progression. 

3.  The  use  of  the  word  of  con.maa.!  for  movements  instead 
of  imitation. 

The  exercises  of  the  .lay's  order  are  always  arranged  under 
the  following  ten  classes,  each  of  which  can  be  made  more  difficult 
or  complicated,  as  is  deemed  advisable  by  the  progress  of  the 
pupil.     The  order  is: 

I.  Introductory  exercises,  class  formations,  facings,  and 
marching  steps  (Fig.  55). 


THE   SWEDISH    SYSTEM   or   GYMNASTICS  55 

rpr:iv;:;r'"''    ^'""' """^ '"'" -''^ - ""^•'- 

rh«,»!!r""^  movement,,  .lesigncl  to  cultivate  elasticity  of  the 


-Introductory  exercise 
ixwition,  neck  firm. 


y>K-  S''-— Arch  flexmn  at  ihe  stall 
Uirt. 


4.  Balance  movements,  or  exercises  of  ecjuilibrium,  reouiring 
h.gh  coo.lmat,on,  rather  than  force,  and  especially  <lirece.l"o 
■mprove  the  posture  of  the  b«ly  (Fi^.  58) 

5-  ShouMer-blade  movements,  exercises  for  the  arms,  usuallv 

le  oh     T'  '''""™  P'*^"''"^  '■^''"™  °f  "'^  ^"est  and  heaci, 
the  object  bemg  to  raise  and  widen  the  chest  (Fig   59) 

abdomen,  and  by  that  means  acting  upon  the  digestive  organs 
and  improvmg  the  natural  support  of  the  viscera  (Fig  60) 


MKHOCOrV    ■■SOWTION  TBI   CHAIIT 

(ANSI  ond  ISO  TEST  CHAIIT  hto.  2) 


Ii25  ■  u 


li^l^B^ 


Jk 


A    APPLIED  IIVMGE    Inc 


653   Eoit   'Join   Strett 
Rocrwiter.   Nam   York         14G09        USA 
(716)  *BI  -0300-PhQM 
(716)  2M  -  5989  -  foi 


96  EXERCISE    IN    EDUCATION    AND    MEDICINE 


F'K-  S8. — Balancing  exercise. 


THE    SWEDISH    SYSTEM   OF    GYMNASTICS 


97 


Fig.  50-— Shoulder-blade  movement. 


7.  Lateral  trunk  movements,  consisting  of  rotation,  sidewise 
flexion  of  the  trunk,  and  exercises  derived  from  these  types  (Fig.  61) . 


Fig.  60. — .\lxlominal  cxerrise  on  stall  bars. 


98 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


I 


8.  Leg  movements,  for  the  purpose  of  relieving  the  engorged 
veins  of  the  fatigued  legs  (Fig.  62). 

9.  Leaping  and  vaulting  over  a  string  or  Swedish  horse  (Fig. 
f>.3)- 

10.  Respiratory   exercises,   accompanied    by   movements   to 
assist  respiratory  activity.    They  are  designed  to  restore  normal 


Fig.  61. — Latrral  trunk  movement. 


respiration  after  the  more  active  work  that  has  gone  before 
(Figs.  64,  65). 

This  order  may  be  slightly  varied  by  introducing,  after  the 
balancing  exercises,  marching  and  running,  or  by  introducing  a 
series  of  heaving  movements  after  the  lateral  trunk  movements, 
thus  increasing  the  groups  in  a  day's  order  to  twelve. 

The  order  of  exercises  is  the  basis  of  the  Swedish  method,  and 
may  be  depicted  graphically  by  the  following  diagram,  repre- 


THE   SWEDISH   SYSTEM   OF  GYMNASTICS 


99 


Kig.  6». — Leg  movements. 


Fir.  63.— Leaping  exercise. 


ipo 


EXERCISE  IN  EDUCATION  AND  llEDICINE 


Fig.  65. — Resptratoiy  exercise  No.  a. 


THE  SWEDISH  SYSTEM  OF  GYMNASTICS  loi 

senting  a  forty-minute  lesson  period,  the  height  of  the  curve 
showing  the  intensity  of  the  effect  on  the  circulation  an<l  respira- 
tion. The  height  of  the  line  for  the  abdominal  exercises  is  prob- 
ably insufficient  in  this  diagram  (Fig.  66). 


I-paiiintf  rstrrisfs. 


Fig.  e6.~Diagram  ot  the  day's  ordpr,  showing  the  lim« devoted  to  each  division  and  the 
amount  of  effort  requited  for  each  (Lefcbure). 

The  apparatus  used  differs  in  certain  i.nportant  respects  from 
that  of  the  Germans.  The  parallel  bars,  horizontal  bar,  and 
spring-board  are  eschewed,  while  the  horse  is  modified  in  form; 
instead  of  these  are  introduced  stall  bars,  boom,  climbing  ladders' 
and  poles,  while  much  use  is  made  of  the  inclined  rope  and  the 
balancing  board.  The  exercise  table  or  plinth  (Fig.  67),  usetl  in 
medical  gymnastics,  is  either  flat  or  adjustab!?  to  different  angles. 

Ling  intended  that  his  system  of  gymnastics  should  form  a 
complete  method  of  physical  education,  designed  to  develop  all 
the  bodily  powers,  but  he  did  not  live  to  complete  his  intention. 
In  the  fragmentary  state  in  which  his  plans  were  left,  and  in  which 
they  have  remained  in  the  hands  of  his  followers,  Swedish  gym- 
nastics as  a  complete  system  are  open  to  the  criticism  that  insuffi- 
cient emphasis  is  laid  upon  endurance,  and  excessive  emphasis 
laid  on  the  constant  voluntary  attention  of  the  pupil.  Their 
accuracy  makes  them  peculiarly  efficient  in  correcting  the  tendency 
of  school-children  to  assume  abnormal  and  hurtful  jjostures,  and 
the  stress  laid  upon  the  proper  carriage  and  movements  of  the 


11 


IM  EXERCISE  IN   EDUCATION  AND  MEDICINE 

trunk  umioubtetlly  serve  as  an  antidote  to  the  evil  effects  of  the 
school  desk. 

Swedish  gymnastics  arc  educational  because  they  are  progres- 
sive, definitely  arranged  according  to  a  fixed  law,  and  require  a 
prompt  response  to  the  word  of  command.  To  be  called  a  com- 
plete system,  however,  they  must  include  the  free  outdoor  sports 
and  games,  on  which  so  much  emphasis  has  been  laid  by  Colonel 
Baick,  who,  recognizing  this  lack,  has  done  much  to  correct  it. 


Fig.  67.— Gymnasium  plinth  (Xarraganrftt  Co.). 

In  many  cases  the  gymnastic  lesson  of  the  Swedish  school  is  non- 
replaced  by  an  hour  of  skating,  long  walks,  or  gymnastic  games  and 
dancing,  and  in  the  training-schools  for  teachers  the  introduction 
of  dancing  steps  and  other  movements  to  music,  which  may  be 
termed  esthetic,  is  not  regarded  with  the  horror  that  it  would  have 
excited  a  fe*  years  ago.  It  may  be  looked  upon  as  the  modern 
development  of  esthetic  gymnastics,  which  Ling  had  in  mind  but 
never  worked  out. 

The  military  gymnastics  need  not  be  dwelt  upon  here,  as  they 
consist  largely  of  fencing  with  the  foil  and  saber,  riding,  and  other 


THE  SWEDISH  SYSTEM  OF  GYMNASTICS 


>03 


militar}'  exercises,  which  are  not  exclusively  Swedish-  in  character, 
but  the  medical  gymnastics,  which  are  so  widespread  in  their 
apphcation,  d.-senc  a  more  careful  consideration. 

Classification  and  practice  of  the  movements  of  massage, 
described  in  another  chapter,  have  been  largely  the  work  of 
Swedish  practitioners,  and  all  the  duplicate  movements  were 
described  and  named  by  Ling  with  extreme  exactness,  so  that  a 
prescription  of  exercise  may  be  written  with  clearness  and  accu- 
racy. 

All  movements  have  a  commencing,  intermittent,  and  ter- 
minating  position,    the    fundamental   positions   being   standing. 


Fi(t.  68.— Dancing  JKps  to  music  (Boston  Normiil  Sciiool  of  Gymnastics) 


sitting,  lying,  and  kneeling.  In  standing  there  are  derivative 
positions  of  the  legs,  like  flexed  standing,  or  of  the  arms,  like  yard 
standing,  or  the  hips  firm  position,  or  of  the  trunk,  like  curved 
standing.  The  similar  derivative  positions  are  described  for 
sitting,  kneeling,  and  lying. 

As  these  are  usually  self-explanatory  and  are  employed  in 
describing  prescriptions  in  the  section  on  Medicine,  no  further 
explanation  need  be  made  here. 


CHAPTER   VII 

THE  "SOFT  BUSINESS  OF  JAPAN,"  THE  "GOSPEL 
OP  RELAXATION,-  AND  THE  "DOCTRINE  OF 
CONTRACTION" 

The  rise  of  Japan  to  the  position  of  a  world's  power  has  brought 
prominenUy  to  the  attention  of  western  readers  an  oriental  exercise 
which  has  been  elevated  to  the  dignity  of  a  system  by  some  writers. 
It  IS  known  as  jiu  jilsu,  or,  in  its  more  modem  form,  jiudo. 

The  origin  dates  back  a^bout  four  centuries,  when  a  certain 
Akiyama  went  from  Japan  to  China  to  study  medicine.  While 
there,  he  saw  a  way  of  fighting  caUed  hakttda,  consisting  of  various 
methods  of  striking  and  seizing.  This  he  learned;  also  twenty- 
eight  ways  of  recovering  a  man  from  apparent  death  (kuatsu). 
He  began  to  teach  it  on  his  return  to  Japan,  but  with  so  little 
success  that  he  went  for  help  to  the  Tenjin  shrine,  and  there 
worshiped  for  one  hundred  days.  One  day,  while  out  walking, 
during  a  snow-storm,  he  observed  a  wiUow,  its  branches  covered 
with  snow.  Unlike  the  pine,  which  stood  erect  and  broke  before 
the  violence  of  the  storm,  the  wiUow  yielded  to  the  weight  on  its 
branches,  but  did  not  break.  Reflecting  upon  this  principle,  he 
began  work  and  invented  over  300  different  holds,  naming  his 
school  Yoshin-Riu,  or  the  spirit  of  the  willow  tree. 

Jiu  jitsu  is  the  art  of  fighting  without  weapons,  and  was  the 
exclusive  possession,  until  about  forty  years  ago,  of  the  Samauri 
or  swordsmen,  of  Japan.  While  it  is  probably  Chinese  in  origin! 
It  was  developed  in  Japan,  where  it  was  practised  by  the  Samauri 
for  the  defense  of  an  unarmed  man  against  1  man  of  stronger 
physique,  or  one  armed  with  a  sword,  club,  or  spear.  Itspbject 
is  to  place  the  antagonist  at  one's  mercy  by  the  mere  pressure  of 


THE  "  SOFT  BlUNESg  Of  JAIAN  "  105 

the  finger  or  hand,  to  throw  him  by  first  disturbii  ij  his  equilibrium, 
and  then  yielding  suddenly  to  his  struggle  to  regain  it.  It  also 
enables  one  to  place  his  opponent's  joinU  in  such  a  position  that 
they  may  U  broken  by  his  struggle  to  free  himself.    It  includes 


rig.  6,.-P^  (rom  .  Iknch-book  ol  Hokuui  (1760-im,)  jhowing:  ,,  Defctu. 
««n.l  a  man  who  icin,  your  (Keikogi)  garnKn.  by  wri«  and  dbow  hold;  ,,  bending 
finiah"""  ""*"'  ^"  '"'  '^  "'"' "" '"  '''^'  *•  '"^  """^  beginning;  5,  finger  hold. 

numerous  methods  of  taking  strangling  holds  about  the  neck  by 
the  hands  alone  or  by  grasping  the  jacket.  Some  of  these  Holds 
are  shown  in  the  sketch-books  of  Hokusai  as  early  as  1750. 

The  art  was  jealously  guarded  by  the  Samauri,  and  marvelous 


io6 


EXEKCUE  IN  r.DUCAnoN  AND  MEDICINE 


i ; 


talcs  were  told  of  their  prowcw  in  it,  but  since  the  abolishment  of 
feudalism,  forty  years  aRo,  the  secrets  have  Income  common 
property.  It  is  now  tauRht  widely  in  Japan,  and  is  part  of  the 
physical  training  of  the  cadets  in  the  naval  and  military  academ-s 
under  the  more  modem  name  of  jiudo.     Its  real  merits  have  been 


70.— Pajp?  from  Holcusai'a  flki-tch-book  iUuMratinK  jiu-Jiizu. 


much  obscured  by  the  extravagant  cUiras  made  for  it  and  the 
exploitation  it  has  received  in  America. 

One  of  the  principal  secrets  of  the  art  was  "  kuatsu, "  or  bringing 
bac,  to  life.  .-Vn  illustration  (Fig.  71)  from  an  old  book  on  the 
subject  will  serve  to  show  the  principle  on  which  this  part  of'the 


THi;  "g^irr  bisinem  of  japan"  ,^7 

art  ««,  U«<l.  The  v«t»  on  the  l«ck  mark  ih.  join.,  „f  iht- 
vertebra-.  The  point  of  the  mi.lHIe  finger  of  the  rixht  hand  is 
place,  on  the  up|K.Tmo,l  one,  an.l  the  h-el  of  the  han.l  is  struck 
smartly  aRamst  the  lowest,  the  left  hand  ,*nK  place.1  on  the 
breast.  -Thus,"  the  .lescription  k<«s  on  to  say,  "you  can  brin^ 
h,m  back  to  life."  This  is  evi.lently  intended  for  a  man  «ho  has 
been  choked,  and  is  strangely  like  the  proce<lure  of  slapping  on  the 
back  for  a  similar  condition,  so  familiar 
to  the  Caucasian  eye. 

Other  illustrations  show  the  knee  in 
the  hollow  of  the  back,  the  hands 
brought  under  the  opimncnfs  arms, 
with  directions  to  |,re»s  on  the  chest  arel 
shove  with  the  knee.  This  and  many 
others  show  varieties  of  artificial  respira- 
tion, but  none  seem  more  efficient  than 
Howard's,  Sylvester's,  or  Schaeffer's 
methods,  as  taught  to  11  medical  stu- 
dents. .Another  i)roc(  ..e  in  the  art  is 
the  pres-sing  on  painful  [xjints.  This 
was  sjioken  of  as  the  "fatal  touch"  in 
the  years  when  the  secret  belonged  ' 
the  .Samauri  alone. 

In  Fig.  72  the  black  spots  show  the 
situation  of  these  "fatal"  points,  and 
pressure  is  made  with  the  point  of  the 
thumb  or  finger,  and  in  most  cases  is 
intensely  painful.  The  circle  on  the 
back  of  the  figure  marks  the  spot  in  which  the  knee  should  be 
placed  in  the  practice  of  resuscitation. 

In  the  practice  of  jiu  jitsu  blows  were  delivered  by  the  ulnar 
border  of  the  open  hand  across  the  larynx,  also  gouging,  kicking 
m  the  face  or  groin,  stepping  on  the  arm  or  leg  of  a  prostrate  foe 
so  as  to  break  it,  and  other  foul  tactics  forbidden  in  boxing  and 
wrestlmg.  It  was  never  considered  from  the  standpoint  of  play 
but  as  the  last  resort  of  a  disarmed  man  whose  life  was  thre-tened 


*""'K7i-  -Katsu{makettlivc). 
When  a  man  is  killol  by  ihc 
collar  or  slranRlc  hold,  put  jour 
left  hand  on  hist  hrcaat  and  mid- 
dle finBer  of  righl  on  fiml  Joinl 
of  the  ..e<k.  and  with  the  heel 
of  the  hand  hit  the  srventh 
joint  of  the  same.  Thus  you 
can  bring  him  bark  to  life. 


im 


f  ■'■ 


io8 


EXEHCISE  U»  EDUCATION  AND  MEDICINE 


In  its  modem  form  these  dangerous  blows  and  holds  have  been, 
for  the  most  part,  eliminated,  and  in  the  best  known  school  of 
jiudo,  that  of  Kano,  in  Tokyo,  it  is  studied  not  only  as  a  physical 
exercise,  but  as  a  moral  and  intellectual  training. 

The  course  is  divided  into  two  parts,  called  "grades"  and 
"undergrades";  the  undergrades  are  divided  into  three:  A,  B,  C. 
There  are  ten  grades,  proceeding  according  to  the  degree  of 
training.  The  teaching  in  all  the  higher  grades  is  devoted  chiefly 
to  mental  training  and  emotional  control.  Every  afternoon  many 
hundreds  of  boys  and  young  men,  mostly  between  ten  and  twenty 


Fig.  7i.-Diagram  o!  Ihc  painful  spots  or  "(aul  touches"  (from  an  old  Japanese  worlc 
on  the  subject). 

years  of  age,  gather  from  all  parts  of  Tokyo  for  practice  in  the 
spacious  hall  of  the  school,  its  floor  spread  with  thick  mats  of 
woven  grass. 

The  constables  of  the  police  department  are  trained  in  the 
system,  and  there  are  now  over  thirty  places  where  jiudo  can  be 
learned  in  Tokyo. 

The  art  was  introduced  to  America  by  J.  J.  O'Brien,  who 
became  interested  in  it  as  inspector  of  police  at  Nagasaki,  studied 
it,  and  finally  came  to  America  to  give  public  exhibitions  and 
private  lessons.  He  modified  it  considerably,  adapting  holds  to 
European  clothing  that  had  been  originally  designed  for  the 


IHE  "  SOFT  BUSINESS  OF  JAPAN  "  109 

Japanese  jacket  and  belt,  and  using  defensive  holds  against  a 
man  armed  with  a  pistol,  as  the  Japanese  used  it  against  the 
swordsman  (Fig.  73). 

In  most  of  the  holds  and  grips  the  strong  and  wealc  jjositions 
of  the  joints  have  been  most  cunningly  considered.  If  we  imagine 
the  wrist  cut  across  the  middle,  to  show  the  position  of  the  tendons, 
it  will  be  seen  that,  on  the  back,  they  are  scattered  and  placed  flat 
against  the  bones,  while  on  the  palm  they  spring  out  against  the 


H 


Fig.  73- 


-Jiu  jttsu  applied  to  a  man  armed  with  a  sword, 
taking  the  sword  from  him. 


RreakinR  the  elljow  and 


ligament,  holding  them  in  their  sheath  (Fig.  74).  The  difference 
in  the  strength  between  flexion  and  extension  is  almost  as  2  :  i, 
and  when  the  hand  has  been  strongly  flexed,  even  that  small 
power  of  extension  is  greatly  reduced. 

BACK 


Fig. 


PAI.M 

-Cross-section  of  the  wrist,  showing  position  of  tendons  and  bones. 


The  object  of  many  of  their  holds  is  to  force  the  hand  quickly 
into  this  position  of.  extreme  flexion,  where  it  is  comparatively  easy 
to  keep  it,  and  where  slight  additional  pressure  produces  great 
pain  (Fig.  75). 


li: 


EXERCISE  DJ  EDUCAnON  AND  MEDICINl: 


Fig.  7S.-Th=  „™.  hold  and  f.U  (uken  from  .„  old  Japa„e«  book).      The  drfen« 
given  19  a  k,ck  in  the  lace,  delivered  when  rolling  over. 

Another  favorite  joint  on  w'hicli  tliey  work  is  the  elbow 
The  power  is  applied  in  one  of  three  ways.  The  joint,  being 
a  hmge  that  locks  when  the   arm  is  straight,  the  forearm  and 


Fig.  76.— The  elbow  hold. 


THE   "SOFT  BCSWESS  OP  JAPAN"  iji 

urm  thus  become  a  long   rigid  lever,  with  its  weak  point  at  the 


:^:^=Ja 


Fw-  7;.— Ruplure  of  Ihe  anli-rior  ligament  following  elbow  hol.l. 


center  (Fig.  76).    If  pressure  be  applied  downward,  at  the  wrist 
and  shoulder   of   the   extended  arm,   wUh   counterpressure   up- 


thc  f™.  ^ff',i7^  I,  ^    ^  ^  '™'"°*  ""  """''  "8'«  '■»"''  "i"-  "'»  '<■"  t'oni 
J  0°Bric:,  "  ""'     """  '"  '"""'"  '"''"■  ■""'  ™  '''™I''I«»J  ''»">  tl>™  by  J. 

ward  just  above  the  elbow,  the  anterior  ligament  will  tear  and 
the  joint  become  disabled.    In  most  of  their  holds  on  this  joint 


Ill 


EXERCISE  IN  EDUCATION  AND  MEDiaNE 


the  man's  own  weight  is  used  as  the  downward  force  at  the 
shoulder  (Fig.  77). 

In  another  lock  the  arm  is  turned  so  that  the  bones  of  the 
forearm  cross  into  extreme  pronation.     Power  is  then  applied, 


Fig.  jg-— «,  Position  o!  the  bones,  sliowinc  the  crossinR  ot  llie  radius  anj  ulna  .nral  llie 
direction  of  the  twist;  h,  position  ot  the  arm  when  the  hold  is  well  taken. 

so  that  the  radius  is  wrenched  out  of  its  sock.,.,  or  the  wrist  ligaments 
torn  and  the  arm  rendered  useless  (Figs.  78  and  79,  a,  b). 

The   principles  of   these   holds   are   comparatively   few   and 
simple,  but  their  applications  are  many  and  difficult  to  acquire, 


THE    "SOFT    BUSINESS   OP  JAPAN"  j,, 

even  imperfectly.  The  holds  are  so  arranged  as  to  pass  from  one 
m.o  another  almost  automatically,  so  that  if  one  s  succe^fuT 
res.sted,  .  e  opponent  usually  struggles  into  a  worse  one  Th  y 
are  d.fficult  and  even  dangerous,  to  demonstrate  with  one  who  U 

unac,ua,nted  with  their  possibilities,  becauseanovice  mayo  tnu 
o     rugg  e  when  he  should  yield,  and  so  do  himself  serioL  injur" 
It  IS  most  unlikely  that  a  small,  '    ' 

puny  man  could,  by  this  means, 
become  invincible  when  pitted 
against  a  powerful,  acti\e  ath- 
lete, but  with  anything  like 
equal  conditions,  it  is  a  most 
valuable  means  of  defense. 


Fig.  8<j.— Position  of  the 
bones  in  rig.  8,.  The  power  ap- 
plied on  the  h.ind  and  upper  arm 
prevents  straightening  of  the 
el  blow. 


Fig.  8i.— This  hold  begins  bygrasping 
the  left  wrist  and  hand  of  the  enemy  with 
your  right  and  bending  the  wrist  into  (les- 
ion. To  escape  the  pain  he  instinctively 
bends  his  elbow  and  so  jumps  into  the 
hold,  as  shown  in  the  illustration.  Thi-s 
hold  was  also  worked  out  by  O'Brien  along 
Japanese  lines. 

In  its  old  form  it  has  no  place  in  our  calendar  of  exercises  o 
sports,  for  It  was  not  a  game,  but  rather  a  way  of  equalising  an 
apparent  disadvantage  in  fighting,  and  it  could  not  be  classed 
among  the  forms  of  exercise  to  be  taught  in  a  school  or  college 
unless  as  an  accomplishment  or  for  purely  military  purposes,  like 
the  French  Savate  (foot  boxing),  which  is  combined  with  the 
bayonet  exercise  in  the  military  school  at  Joinville. 

8 


Vi 
I  ■■1 


p 

§1: 


»3 


nm 


114 


EXERCISE  IN  EDl'CATION  AND  HEDICINE 


In  its  modem  form,  as  developed  by  Kano  and  his  pupils, 
these  dangerous  locl^s  are  barred,  and  trips  and  throws  are  almost 
exclusively  employed,  great  emphasis  being  laid  on  ways  of  falling, 
so  as  to  prevent  injury  from  shock  of  the  hard  floor  or  mat.  It 
thus  becomes  like  a  combination  of  collar  and  elbow  wrestling  and 
tumbling,  and,  as  such,  is  a  distinct  addition  to  our  repertoire  of 
exercises. 

It  is  not  probable  that  any  great  or  permanent  influence  will 
be  exercised  by  jiudo  on  the  methods  of  physical  training  in 
America,  foreign  as  it  is  in  origin  and  aim  to  Anglo-Saxon  ideals. 
Physical  education  has,  however,  received  distinct  contributions 
from  other  lands  besides  Germany  and  Sweden,  which  have 
appealed  to  the  national  temperament  and  have  become  absorbed, 
modifying  its  development  to  a  marked  degree.  Many  of  these 
systems  or,  as  Hartwell  terms  them,  "systemettes"  have  had  a 
more  or  less  ephemeral  existence,  and  the  main  object  of  some  of 
them  has  been  other  than  the  development  of  the  body  by  muscular 
exercise.  ' 

THE  DELSASTE  SYSTEM 

Perhaps  the  best  known  of  these  lesser  systems  is  one  that  has 
been  both  exploited  and  maligned,  under  the  name  of  Franjois 
Delsarte,  a  Frenchman,  bom  at  Solesme,  in  1811.  At  the  age  of 
twelve  he  was  sent  to  Paris  to  study  painting  on  china,  but  his 
tastes  carried  him  in  other  directions,  and  he  became,  in  1825,  a 
pupil  of  the  conservatory,  a  government  institution  for  instruction 
in  acting,  music,  and  the  ballet.  Here  he  lost  his  singing  voice, 
and,  finding  himself  incapacitated  for  the  stage,  he  resigned  that 
career  to  study  and  teach  elocution  and  dramatic  art. 

After  nun'-  years  of  thought  and  observation  he  succeeded 
in  formulating  what  he  termed  the  laws  of  esthetic  science,  which 
had,  he  claimed,  the  precision  of  mathematics.  Like  all  enthu- 
siasts, he  remained,  until  his  death,  in  1871,  on  the  eve  of  a  series 
of  discoveries  which  he  felt  would  revolutionize  dramatic  expres- 
sion. 

He  never  published  an  adequate  account  of  his  researches, 
but  his  scattered  and  fragmentary  notes  were  collected  by  Alfred 


THE  DELSARTE  SVSTEU 


"5 


Giraudet,  of  the  Gran.l  (),,era,  Pari.,  his  favorite  pupil,  and  by  his 
daughter,  Mar,.  .Madame  Geraldj),  whose  tour  in  America  will 
be  referred  to  later. 

Delsarte  believed  that  the  perfect  reproduction  of  the  char- 
acteristic posture  will  pro<luce  the  emotion  dej.icted  by  the  actor 
and  much  of  h,s  work  may  be  described  as  an  attempt  to  classify 
and  make  sc.entific  the  empiric  rules  of  the  pantomime.  Positions 
of  the  fingers,  hands,  and  legs  are  named  and  classified,  and  the 
expres^sions  of  the  mouth,  nose,  and  eyebrows  are  discussed  in  a 
way  that  recalls  the  quaint  studies  on  physiognomy  l,y  Levator 
Gesture  as  a  form  of  language  was  his  constant  study.  He 
writes:  When  a  man  says  to  you,  in  interjective  form,  'I  love 
I  suffer,  I  am  delighted,  etc.,'  do  not  believe  him  if  his  shoulder 
remains  m  a  normal  attitude.  Do  not  believe  him  no  matter 
what  expression  his  face  may  assume.  Do  not  believe  him- 
he  lies;  his  shoulder  denies  his  words.  That  negative  form 
betrays  his  thoughts." 

The  system  designed  by  him,  and  carried  on  by  his  immediate 
folowers  analyzed  form,  poise,  and  gesture  in  relation  to  emotion, 
but  much  of  his  writing  shows  the  enthusiast  and  the  dreamer 
His  theories  were  made  practical  by  his  strong  personal  magnetism 
and  the  social  gifts  that  made  him  a  welcome  guest  at  more  than 
one  royal  table. 

He  himself  did  not  elaborate  any  system  of  gymnastics  to 
develop  the  body,  but  he  did  teach  a  few  principles  and  exercises 
necessary  for  stage  falling  and  other  maneuvers  in  acting 

The  work  of  Delsarte  was  brought  to  the  attention  of  .Americans 
by  his  most  ardent  disciple,  Steele  Mackave,  who  planned  to 
bring  his  master  to  .\merica  to  lecture  on  and  demonstrate  his 
Ideas.  Unfortunately,  the  Franco-Prussian  war  intervened  and 
he  died  during  the  Commune. 

His  teachings  were  made  into  a  system  of  physical  culture, 
the  motto  of  which  was  "relaxation,"  by  Mackaye,  Genevieve 
Stebbins,  Emily  Bishop,  .Anna  Payson  Call,  and  others,  and 
when  his  daughter,  Marie,  was  induced  to  make  a  tour  in 
America,  she  found  her  father's  theories  so  distorted  and  mis- 


ii6 


EXERCISE   IN   EDUCATION    AND   MEDICINE 


sriazs. 


CRITOUON  or  THE  HAim 

i 


Fig.  8j.— Delsarte  system  of  orator}-  (E.  S.  Werner). 


RECAPITULATION. 


'  ^  C  Cbncentro-concentric. 

3  <  Normo-concentric. 
^  I  '  Eccentro-concentric. 

2  e  Concenlro-noi  Rial. 
k  3  <  Normo-normal. 
Ill  Eccentro-nomial. 
'  2  f  Concentro<eccentric. 

3  s  Normo-eccentric. 
'  I  '  Eccentro-eccentric. 


Conflicr. 

Tonic  or  power. 

Convulsive. 

Prostration. 

Abandon. 

Expansion. 

Retraction. 

Exaltation. 

Exasperation. 


represented  that  she  refused  to  identify  his  name  with  the  move- 
ment, and  confined  her  attention  to  giving  semiprivate  lectures 


THE  DELSA«TE  SYSTEM  j„ 

Lafontame  s  fables  accordinK  to  the  rules  taught  hy  him 

m  Its  Amencaniml  form,  the  «,.call«l  Delsarte  method  had 
a  great  vogue   n  schools  for  young  ladies  and  in  socie"   and  iUs 

iir' ^Hei^tvx;:.?^^  ^^- -""•  •■'^-'-'- "^ 

exercise  from  Emily  Bishop's 
book,  "Americanized  Delsarte 
Culture": 

"Hold  some  thought  of  tran- 
quillity, sitting  erect,  so  that  the 
feet  easily  rest  upon  the  ground. 
Look   steadily  at  some  {Mint  in 
the   ceilinp,  and   take   five  slow- 
deep   breaths.     Let   the   eyelids 
droop  heavily  and  the  head  sink 
gently,  the  chin  resting  upon  the 
chest.     The  back  relaxes  as  far 
as  ijossible,  vertebra  by  vertebra. 
Last  of  all,  the  hip-joint  relaxes, 
causing  the  head  to  sway  forward 
until  it  reposes  in  the  lap.     In 
returning  to  the  original  position 
reverse  the  order  of  action.     The 
hip-joint  acts  first,   the   motion 
creeps   up   the    back,   until    the 
spinal  column  regains  its  double 
curve,  which  lifts  itself  to  its  nor- 
mal poise,  after  which  the  eyelids 

languidly  open,  as    they  do  in  babies  when  a  little  one  seems 
unw,llmg  to  surrender  to  heavy  drowsiness. 

-This  exercise  secures  a  threefold  benefit:  It  develop,  sin 
^ess  of  attention;  it  partially  stupeBes  the  brain,  and  d'  e  Uy 
»o.hes  the  nerves.  Affect  the  spinal  column  in  any  way,  and  the 
entire  nervous  system  sympathizes.    When  accurately  done    i 


F«-  Sj.— The  riiht  and  wrong  ways  of 
raising  an  arm  according  lo  the  Dcisar. 
tian  leaching  o(  rclanalion  (Cassell's 
"Physical  Educator"). 


!     , 
U  i 


Ii8 


EXERCISE  IN  EUl'CATION  AND  MEDICINE 


always  produces  a  sensation  of  ileepiness.  It  is,  however,  difficult 
to  get  the  controlled  even  motion  that  is  essential  to  tranquillize 
the  nerves.  This  usually  requires  considerable  practice  under 
the  direct  attention  of  a  teacher.  Such  an  exercise  should  occupy 
from  three  to  five  minutes.  From  three  to  five  repetitions  should 
produce  drowsiness  sufficient  to  make  one  unreservcilly  relax 
and  sleep." 

Anna  Payson  Call,  who  also  preaches  the  gospel  of  relaxation, 
emphasizes  self-suggestion  to  overcome  the  chronic  condition  of 
nervous  tension  so  frequent  among  American  women,  and  it  is 
this  thought  that  has  been  a  real  contribution  to  physical  education. 

Delsarte  may  be  said  to  have  been  the  greatest  influence  in 
directing  attention  to  economy  of  muscular  action  in  expressing 
thought,  and  his  principles  continually  crop  out  in  such  schemes 
of  gymnastics  as  that  of  C.  W,  Emerson,  given  in  connection  with 
his  school  of  orator)'.  While  he  has  a  comparatively  small  nuL.ber 
of  exercises,  without  apparatus,  he  insists  on  their  continual 
repetition,  with  the  purpose  of  perfecting  each  one.  The  points 
upon  which  he  chiefly  insists  are  the  active  [xsition  of  the  thorax, 
the  spine  erect,  and  the  abdomen  drawn  in.  He  speaks  much  of 
the  poise  and  balance  and  graceful  control  of  the  limbs. 

The  benefit  of  such  exercises  is  not  to  be  questioned,  particu- 
larly in  slight  cases  of  prolapse  of  the  viscera,  where  the  chest  is 
collapsed  and  the  abdomen  protrudes. 


THE  DOCTRINE  OF  CONTRACTION 

As  if  to  offset  this  "  gospel  of  rekxation, "  a  number  of  systems 
have  spnmg  up,  built  on  the  doctrine  of  intense  simultaneous 
contraction  of  as  many  muscles  as  possible  in  performing  a  simple 
movement. 

Sandow  endeavored  to  found  a  system  for  complete  develop- 
ment on  this  doctrine,  using  the  spring  dumb-bell  (Fig.  84),  an 
instrument  of  his  own  invention,  which  required  continuous  con- 
traction of  the  grasping  muscles  to  compress  the  spiral  springs 
separating  the  two  halves  of  the  handle. 

Macdonald  Smith,   in  England,  has  his  system  of  "full  con- 


IHl  DOCTRINE  OF  CONTRACTION  ng 

tractions"  for  rapid  development  of  the  entire  muscular  system, 
but  It  19  m  connection  with  the  " corres|)on(lcncc  schools"  of 
"physiologic  exercises,"  whose  allurinK  promises  and  attractively 
iUustrated  a<lvertisement»  have  dccorale.1  the  maRazines  for  the 
past  few  years,  that  the  doctrine  of  contraction  has  had  its  widest 
publicity.  In  a  circular  sent  by  one  the  writer  bcRins  by  stating 
that  "all  movable  parts  of  ti!c  Ixxly  have  muscles  to  move  them 
one  way,  and  also  have  uscles  to  move  them  back  again,"  s.. 
that  by  using  one  muscle  or  group  to  resist  the  action  of  its  ant:  go- 
nist,  the  same  development  can  be  reached  as  by  the  use  of  weights 
It  is  claimed  that  the  alternate  contractions  and  relaxations  help 


Fig.  84  — Sandow'i  spring  duml>-!iell. 


the  venous  circulation,  and  instead  of  obstructing  the  circulation 
of  the  capillaries,  would  accelerate  the  blood  in  its  course  toward 
the  heart.  The  use  of  one  muscle  to  antagonize  another  is  the 
prmciple  upon  which  this  and  other  systems  are  built. 

A  typical  exercise  would  be  the  simple  flexion  and  extension  of 
the  arm,  durmg  which  the  attention  is  concentrated  on  the  flexors 
of  the  arm  (Fig.  85).  The  fist  is  tightly  clenched,  and  the  arm  is 
slowly  flexed  ith  intense  resistance  from  the  lengthening  triceps 
so  that  during  the  movement  the  entire  arm  is  in  a  state  of  tension' 
To  mcrease  the  effect  the  subject  stands  with  knees  everted  and 
slightly  bent,  and  the  muscles  of  the  thighs  in  vigorous  contraction. 


I 


lie 


EXMCME  IN   EDUCATION  AND  MEmciNE 


The  cxerc.^  «  never  complicated  or  el.l«niU-.    They  arc 

Although  there  is  Imlc  oriKinallty  in  their  ,lc,ig„,  ,l,„c  is  a  novelty 
m  he  manner  of  their  statement  that  appeal.,  to  the  uninformed 
»n.!  (lartly  mformed  with  the  force  of  a  new  truth. 

The  advantage  of  such  movements  to  a  busine«,  man  who  i., 
not  aml>,t,ous  to  excel  in  g«ne»  or  s,x,rts,  l,ut  who  wishes  to  get 


«nd  leg  muwiea.  " 

his  necessary  exercise  in  "tabloid"  form,  is  evident,  and  it  is  to 
h>rn  tha,  such  a  pro,x«i,ion  makes  its  appeal.  Great  numbers 
can  be  treatecl  at  the.r  homes,  through  written  <lirections  sent  "  v 
ma,l,  and  ephemeral  institutions  are  formed  in  the  business  sec- 
nons  of  c,t,es  and  mied  with  patients  by  a  personal  canvass 
from  office  to  office.  Twenty  minutes  daily  of  this  intense  worlc, 
mvolving  the  large  muscle  groups  of  the  legs,  trunk,  and  shoulders 
powerfully  stimulate  the  heart  and  resp.ration,  draw  the  blood  out 


THK   WICTHINK  or  tONT«ACTIOM  ,„ 

to  the  cxtremijios.  .„.|  cau»  p  .fu,,.  ,«r,„irati.,„.    Wh.n  full„«„| 

<>r  to  l,f,,  ami  tnc  .Iru.lKcry  of  it  U  not  without  its  koo,I  .K.inlH 
Tc^  exercises  will  ,„,ckly  develop  the  muscuH  f  ^ 
merest   for  a fme   many   who   woul.l  no,  otherwisl-  take  any 

Zir        1-.  "'  ">"«"'"  ""vements  of  every -,lav  life  ami 

her  ab,l,ty  to  «i,e  all-arouml  .levelopment,  is  anmher  ma,  e 
In  th,s  respect  they  ,lo  no,  stan.l  the  test  well.  In  such  a  »  r^ 
there  are  no  movements  rerjuirinK  fme  or  complicate,!  c^rla  i  1 
an<l  here  are  none  that  aim  at  the  ac.,uirement  „f  skill  oTtt,,' 
For  a  man  who  wishes  to  excel  in  playing  a  «ame  like  golf,  ,  ™  ' 
or  any  other  game  r«,uiring  lithe,  graceful,  an.l  accurate  motion' 
n.e«  exercises  are  no,  only  valueless,  but  .letrimental  tZ 
make  h,m  muscularly  sc-lf-conscious,  ami  break  ,p  that  fine  a.lj^t' 

r  m  „r  Thet"" "  "TT""  '•' ''"'-''  ^'™«-  "--•"« 

ment  of  any  muscular  act,  and  they  o,erlook  the  im,x,rtance  of 

c  iot   :,   t  "  "'"^'T  "'  ""  "'""'  '^'^  ^''--'"''•-  "f  -  h 
aeons   as   throwing,    thrustinp,    .nd    striking,    so   necessarv    to 

occupations  The  strain  put  upon  the  circulation  by  this  excessive 
con tracon  is  also  great,  and  may  overstrain  a  heirt  orga^lv 
weak  or  encumbered  by  deposits  of  fat.  organically 


CHAPTER   VIII 
AG^  SEX,  AND  OCCUPATION 

Growth  and  development  are  directed  by  the  play  instinct 
an  automatic  system  of  physical  education.  While  the  man-made 
systems  that  have  just  been  described  can  be  successfully  brought 
into  requisition  at  the  later  stages  of  a  child's  progress  to  maturity 
y  are  comparatively  insignificant  and  his  neuromuscular 
development  is  principally  due  to  spontaneous  exercises  of  his 
own  creation. 

To  be  effective,  physical  education  must  travel  along  the  same 
road  as  that  naturally  used  by  the  growing  boy  or  girl,  unhampered 
by  artificial  conditions. 

The  first  movements  of  the  infant  consist  of  spontaneous 
kicking  and  squirming,  with  aimless  motions  of  the  arms,  hands, 
andhead  .As  he  progresses,  more  complicated  movements  are 
mtroduced-the  picking  up  an^  dropping  of  objects,  digging  and 
P  ling  up  sand,  and  playing  with  blocks  and  other  toys.    Movements 

fnu'^  Ju'TT"""^'"^-  ''""•'"«  '"  "•*"'  '""^  ^"'"P-^re  soon 
followed  by  the  boy's  interest  in  throwing  and  cutting  with  a  knife 
About  the  age  of  seven,  catching  and  all  games  of  ball  begin  to 
engage  his  attention,  with  individual  games  like  tag.  hide-and  seek 
leap-frog,  and  other  tests  in  which  his  awakening  powers  are  tried' 
but  It  IS  not  until  the  age  of  twelve  that  the  boy  begins  to  find 
his  medium  in  the  competitive  games-those  games  demanding 
the  sacrifice  of  the  individual  to  the  team. 

This  law  is  graphically  shown  by  Dr.  Luther  Halsey  Gulick  in 
^e  accompanying  chart,  in  which  the  plays  of  the  .\nglo-Saxon 
boy  are  tabulated. 
'  His  life  is  divided  into  three  periods-from  birth  to  seven 
from  seven  to  twelve,  and  from  twelve  to  maturity.  The  spaces 
inclosed  by  the  curved  lines  include  the  games  that  are  acquired 
at  each  stage  and  also  those  that  are  retained  to  a  more  advanced 
age.     These  lines  must  .nt  be  considered  as  final,  since,  in  many 

laa  -^ 


AGK,    SEX,    AND   OCCUPATION  „, 

drift  from  plays  that  center  in^h.i-- ■    t  "^^  P^^^^^^^^  «hey 

considers  hV«.l    Ite^'To  othej     G^"l'°  "'""  '"  ''''''''  *"= 
aira  lo  others.     Growth  is  accompanied  by 


BtKvm 


"4 


EXERCISE   IN   EDUCATION  AND   MEDICINE 


It  mu  t  no  be  forgotten,  however,  that  the  games  acquired  in  the 
s^con.  per,od  a^so  persist,  and  often  dominate  the  boj  through™ 
h.s  entire  growth.     Gulick  has  pointed  out  that  sava/es  who  have 
leached  the  stage  of  cooperation  required  for  fightingtnder  a  chi^ 
m  organized  tribes  are  really  doing  what  the  Anglo-Saxon  W 
does  at  the  age  of  twelve.     All  the  higher  forms  of  sport  involi^ 

theTaTof  "1  r™'""'""  ^"  •"'^"'^  ^  physical  expression  of 
the  aw  of  evolution  that  governs  the  business  and  social  life  of  a 
civilized  community. 

.on  niust  always  be  given  to  this  law  of  physical  evolution.  The 
formal  gymnastics  have  no  place  among  the  young  child's  physical 
exercises,  but  his  natural  plays  and  games  are  developed  and  u  "d 
educationally  for  his  ph)  .ical  welfare 

his  StnT"'  ""'  '""'™™""  '^"- '"'  ^-'^"'P'"  '•'  -» 

Until  the  age  of  twelve  there,is  but  little  difference  in  the  spon- 
taneous play  of  boys  and  girls,  but  with  the  consciousness  of  sex 
and  the  accelerated  growth  of  puberty  their  interests  rapidly  diverge 
Girls  retain  their  individualism,   and  do  not  come  under   the 
domination  of  the  "gang"  instinct  to  the  same  extent  as  boys 
Their  interest  turns  to  more  feminine  accomplishments,  requiring 
grace  and  lightness,  and  much  pleasure  is  found  in  dancing  in  all 
.ts  forms  and  in  games  in  which  rhythmic  movement  is  prominent 
It  IS  not  until  a  comparatively  mature  age  physically  that  the 
more  formal  gymnastics  can  be  introduced  and  their  correction 
applied  to  the  confinement  of  school,  shop,  or  home  life      The 
games  accompanying  them  must  also  be  chosen  with  reference  to 
the  natural  desires  found  in  normal  children  of  that  age 

During  adolescence,  sports  and  games  play  so  large  a  part  in 
physical  development  that  a  definite  classification  of  theoutstand- 
mg  effects  of  the  most  familiar  of  them  is  given  in  the  table  (pp 
126,  127)  for  guidance  in  their  selection. 

It  is  impossible  to  give  any  great  degree  of  exactness  to  such  a 
able  without  cumbering  it  with  wearisome  explanations.  In  a 
familiar  exercise  like  walking  the  change  in  speed  from  three  to 


AGE.   SEX    AND  OCCIPATIOX 

stimulating  the  h    r     lunT      T  T"''  ""^'  '""^'^-  «™"r«  and 

bedangerolrVHrltXraratlr-""'"  ^'•"^-  ^-^ 
ground.  nigni  «  alk  at  moderate  speed  on  level 

the  movement.     The  "inlen  "^'"^  "'"'  ""=  '''''«^"">-  "f 

of  an   exercise   J  ndiij  .^  "'"'"'r?  ^"''  ^■■-"''"'•™" 
increase  in  .he  l.lood-presfure  a,^  „I"    »'  '-athlessness  and 

The  chief  characterful -ritt:      7  "  """''"■ 
necessary  for  success  in  s„.h  ^        ™"'"'"'  '''^Petition 

and  the^age  Unr:::^t^i:':^zf^^ ''--^  ^^o^^m., 

placed  in  the  last  but  one      The  tim      ~J"  '""^'"^'^  are 
leaving  off  any  exercise  mnsf  '''  '"  '^^•^'""'■"g  ""'I 

'- the  ages  mL:rr:rr:  ,:irSe::r^ '-•'^■''!-'' 

^r  His  conditionrrri";:;!  rSeii:  :r  ^-"tr 

of  receivmg  guidance  from  this  chart  '  '"'"'''" 

sports  as  cricuTSb     ,  ^[J^  '"tZl'  ''"■'  '"  ""'' 
has  been  continued  with  regu  artv   f '  n,  'T'  '"  "  ^''°" 


136 


EXERCISE  IN  EOUCAnON  AND  MEDICINE 
CLAS^FICATTON  OF  ATHLETICJIAMES  AND  EXERCISES. 


Bi>w)inK. 
BoxinK. 
Cricket. 


Cross  coun- 
try running. 


Right  or  Irft  /ore- 
arm,  shoulder,  and 
the  whole  muscular 
system  lo  a  lesser 
deKTce, 

Right  farearm.  arm. 
shoulder,  and  bjiclt. 

All  at  forearm.aiTTB, 
■houldera,  chest, 
back,  and  thighs. 
The  whole  muscu- 
lar system  mod- 
jTately;  right  or 
left  forearm,  arm, 
and  shoulders. 

Thighs  iind  legs. 


,  Moderate.  Accuracy. 
I  speed,  and 
I     agility. 


Extreme. 
Great. 


Dundng.      Thigh,  and  legs.       ]  Extreme,  i    Great, 


Slighl.        Accuracy 
and 
strength. 
Great,    i  Alertness, 
agility, 
strength. 
Moderate.     Accuracy, 
speed,  and 
agUity. 

Extreme.  |  Endurance, 

speed,  and 

strength. 

Eoduiance 

and 

agUliy. 


Football. 

(socker). 


Football. 
(Rugby). 


Thighs  and  legs.       ■  Moderate.  J 


Qreat. 


I 


Hammtr- 
th  rowing. 


Hand-ball. 
Hockey. 


Jumping 
(high). 
Jumping 
(hnntV). 
I^cr(>sse. 


The  whde  muscu- 
I    lar  system. 


,  The  whole  muscu- 
I  lar  system  moder- 
I    ately. 


Shoulders  and  back, 
also  arms  and 
thighs  to  ft  lesser 
_  degree. 

The  whole  muscu- 
lar  system,    par- 
ticulariy  the  back. 
The  whde  muscu- 
lar  system,   espe- 
ciiilly     the     back 
and  right  (or  left) 
forearm. 
The  whole  muscu- 
lar   system,   espe- 
cially the  alxtom- 
inala,thj(hs.  ham- 
strings, and  calves. 
Thighs.  I'.wer  back, 
and  shmilders. 
Thighs,  calvc.  kick, 
and  shoulders. 
All  the  muscles  of 
the  legs  and  ortna. 


Extreme. 
Extreme. 


Extreme. 


fireat. 


Agilil}. 
speed,  and 
strength. 


Accuracy, 
endurance, 

speed,  and  i 
agility. 
Slight        Accuracy.   1 


ia-30.  Amount   of    exercise 
depends  on  the  posi- 
tion played;  pitcher 
.  has  his  [Etching  arm 
i  ccnslanUy     over-' 
'  worked. 
14-60.  , 


16-40. 

«hSo.  Depends  nn  position 
;  plaj-ed;  exercise  ob- 
tained by  bowler  is 
j  different   from  that 
of  the  fidder. 
i8-as-  A  severe  lest  ot  the 
'  heart. 

14-40.  Clog   and   soft  shoe 

I  exercise     only    the 

!  legs,  but  many  acro- 

I  batic   postural    an<; 

!  esthetic    dance: 

i  bring  in  the  trunk 

and  arms. 

"-.(5-    In  this  game  the  ImII 

j  is  not   touched  by 

the  bands,  but  is 

kicked  by   the   feet 

and  butted  by   the 

I  head  only, 

16-30.  The  moat  severe  field 

I  game  on  the  heart 

I  and  lungs. 

ii-60.  The    walking    inter- 
rupted  by    the 
strokes  of  the  game 
make   it   peculiarly 
valuable    tor   those 
living    a    sedentary 
mdow  life. 
16-S0.  !A  difficult  feat  of  co- 
•  ordinatitm    as   now 
;  practised,  i.e.,  from 
:  a  j-foot  circle. 
1-40. 


la-as.  An  extreme  test   on 
I  the  heart  and  lungs, 

16-3.1.  The  hi^h  hurdles 
(i  ft.  6  in.)  require 
great  accuracy. 


I  Jumping   without    a 
I     run  cultivates  ;igil- 
ity  onlv. 


ia-30.    A  running  game. 


AGE,   SEX,   AND  OCCl'PATION 


"7 


j  Influcnre 

Ewr.be.      f hW  region! ./  .he  '  r»«nami  ;  '?,P^«- 


txidy  UMcd, 


dffliS"  "Si^t:'  '■-■  »■'  '"'«'"■ 


plralinn, 
Extreme. 


Phydca] 

characlcr- 

irtlri  rulti. 

valed. 


BcM 

use  for  ] 
IJrar  i 
ti<e. 


P<Je. 
vuutiing. 

Riding 
(honehtttl). 

Polofjiony), 


Running, 
loo-aoo  yds. 


Running 
440-1000 

yds. 
Distance 
runntns  (i 
mile  and  up- 
ward). 
Rowing. 


F.jrearm,         arms.     Extreme. 

shoulders,     abdo-  , 

men,   thighs,   and  ' 

legs.  I 

Back.       abdomen. 

and  thighs. 


Endurance.  '  16-40.  A  wvere  teMi  ,m  the 

,   Miirt     and     lunga, 

SlS^l'*''''  'n  high 

"trength. 


Siight. 
Extreme. 


Right  or  left  arm. 

back,     abdomen, 
I    oDd  legs. 
Whole       muscuLir  ;  Extreme 

system,   especially  I 

ihe     thighs     and 

calves.  I 

The  whole  muicu-  1    Creit 

far  system  except  I 

the  arms, 
Thighs  and  calves.  'Moderate. 


Extreme. 
Extreme. 


Kdann 


Accuracy, 
balance  .and 
strength. 
Speed  and 
aierinesfl. 


SfPed  and 
endurance.  1 


Endurance 


14-60.   Themechanicalshak. 
iBg    has  a   distinct 
I    "'*'^I*u''c  effect. 


U-30.   A  Wpitat  exercise  n( 


A  typit 
eOorl. 


Shooting 
(hunting). 


Target. 


Shot. 

putting. 

Swimming. 


Back,  fOTearm.  arm 
flexors,  shoulder 
mu»tles.and  thighs, 
The  whde  muscu- 
lar system,  espe- 
cially the  thighs, 
"egs,  and  back.  > 
The  whole  muscu-  j  Extreme, 
lar  system,  very 
moileratdy.  Arm 
flexors  and  all  of 
forearm,  ' 

Right  for  left)  fore- 
arm, triceps,  shoul- 
ders, back,  and 
thighs. 

The  whole  muKu- 
lar  system. 


I 


-a^   A  severe  lest  on  the 
heart  and  lungs. 

-as-   A  severe  test  on  Ihe 
I  heart  and  lungs. 


Slight,    i  Extreme.       Strength 


Wlsht.      Moderate, 


endurance. 
Endurance. 


Slight.        Accuracy. 


1     Great.        slight. 
Moderate,      (ireat. 


Tennis, 

Walking. 

Water  polo. 
Wrestling. 


I  The  whole  muscu- 
lar   system,    eape- 

j  c;ially  right  for 
left)  forearm  and 
arm. 


!    Strength. 

speed,  and 

agility. 

Endurance  ! 

and 

strength.    1 


T^vha    _.. 

eully  unused,  except 

,f.  ^  i,*;*'"he  sliding  scat. 

16-60.  |\alue     depentra     on 

tramping    over    ir- 

'  regular  ground  and 

'  open  air. 

"4~6o. 


>6-,W. 


Great.      .\fo<leraIe. 


Accuracy, 
speed,  agil- 
ity, and 
endurance. 


ThiirV.-, 
I     Lack. 


!«^KS    and       Slight.      .Moderate.  Endurance. 


Whole 

system. 

Whole  muscular 
sj-alem.  t  -wcially 
neck,  ba  ,  arms, 
shouldei  and  ah^ 
dom.-n. 


muscular     Extreme.     Extreme. 
Extreme.       Great. 


Endurance, 
Btrength. 

and  agilily. 
Strength, 

endurance, 

agility,  and 
speed.      F 


ia-60.  Racing    and    diving 
a"*  extreme  tests  on 
■  the  heart  and  lungs. 
Swimming  for   chs- 
I  tanceat  a  .  i.iderate 

speed  is  a   test    of 
i  endurance  and 

I  stamina. 
14-40.  Tennis-elbow        ia 
I   caused  by  constant 
repetition   of    back- 
I   hand    stroke,    pro- 
ducing  strain  of  pro- 
I  nator     radii      tera 
muscle. 
16-60.  Two   to   four   miles 
i  an  hour  is  mild  exer- 
ciM-     Fcnir    to   six 
miles   may   be    ex- 
hausting, if  kept  up 
very  long  or  if  road 
IS  rough. 
10-3S.  An   extreme   lest   of 
the  heart. 

16-40.  I 


"I 


138 


EXERCISE  IN   EDICATION  AND  MEDICINE 


From  the  standpoint  of  therafjcutic  effect,  or  even  of  rapid 
development,  most  athletic  games  are  inaccurate  and  wasteful 
of  time.  For  these  purposes  they  do  not  compare  with  the  accurate 
movements  of  formal  gymnastics.  During  a  baseball  game  an 
outfielder  may  spend  four-eighths  of  his  time  standing  with  his 
hands  on  his  hips,  another  three-eighths  sitting  on  the  bench,  and 
the  remaining  one-eighth  at  the  bat,  on  the  hp-ts,  or  in  the  practice 
of  throwing  the  ball.  For  an  expenditure  of  two  hours  or  more 
he  gets  nothing  but  fresh  air  and  a  little  exercise  for  his  right  arm 
and  shoulder.  In  a  game  of  foot-ball  the  time  occupied  in  actual 
play  is  only  four  or  five  minutes,  the  rest  of  the  time  being  spent 
in  discussion,  disentangling  the  team  after  a  play,  and  in  preparing 
for  the  next  play,  the  exhaustion  following  a  game  being  largely 
nervous. 

Games  and  gymnastic  exercises  especially  designed  for  a  spe- 
cific purpose  can  be  applied  to  remedy  defects  or  weakness  more 
quickly  and  surely  than  sports  whose  object  is  recreation  alone. 
No  game  growing  up  in  a  community  of  children  could  teach 
alertness  like  Dr.  Sargent's  "curtain  ball,"  a  game  in  which  two 
courts  are  separated  by  a  curtain  eight  feet  high,  each  side  attempt- 
ing to  throw  a  basket-ball  so  as  to  touch  the  floor  of  its  op;onent's 
court  and  at  the  same  time  defend  its  own  from  a  similar  fate. 

Gymnastic  apparatus  was  originally  made  to  imitate  the  tools 
and  appliances  of  the  outdoor  world.  The  horizontal  bar  was  at 
first  the  branch  of  a  tree,  the  climbing  pole  a  mast,  and  the  ropes 
its  rigging.  The  wooden  horse  of  the  gymnasium  dates  from  the 
days  of  chivalry,  but  the  agile  and  complicated  movements  that 
give  it  interest  and  value  would  be  impossible  or.  its  living  proto- 
type. Many  of  the  exercises  on  the  horse  would  indicate  that 
it  also  represents  a  log  on  which  to  balance  and  from  which  to 
leap. 

In  the  following  table  the  main  characteristics  of  the  more 
familiar  pieces  of  gymnastic  apparatus  are  classified  as  they  were 
in  athletic  games. 


AGE,   SEX,   AND  OCCCPATIO.V 


I  Demand    Influme  '  f  ~"~     f^     "     ' 

coardf.       napjra-      tu'tivalH.  i     age 


I'Viijirki, 


Buket- 

twU. 


Bom 

(Swedish). 


Buck. 


Extreme.     Extreme. 


Flyjng 
riags. 


j  The    whoJe     mui- 

<:"'"  »>Mem.  n 

r«ially        legs, 

thighs,  and  lower 

trunk. 
f1«ors    nt   linaers.    Mudcr,,-       u-  t,. 
'     wnst.     and    Rwe-      '"""'"  ^-      W'Bht. 
arm.      flexor*     ,rf 
arm,  all  .rf  shoul- 
der,    and      aWo- 

1-^'  "(rf  forearm, 
arm.  ami  shoul- 
ders; ihighs.  and 
legs. 


Agiliiy,  ac- 
curacy, and 
endurance, 

Strciwth 
t*iilantL'. 


Hexnrs    of     hand. 
I    wnsi,        forearm, 
arm.       shoulders, 
Horizontal     Fw"^^"!'"^'"'- 

arm.  pectoruls.  la- 
tiwmusdorsi.and  , 
abdominal  mus- 
cles. 
I  All  of  f.jre  irm. 
i  arm,  shoulders, 
j  abdnm.-n,  thighs, 
and  legs. 

j  AU  of  forearm,  arm, 
!  shoulders,  abdo- 
I  men,  Ihighs,  and 
I    legs. 


Hone 

<lung). 


Horse 
(»idej. 


.\l.xler..e.      Slight. 

[ 

Great.     .Moderate. 

Extreme.   Moderate. 

'  i 

.Mo^Ierale.  M,Klcr;,te. 


AgiUiy,  bal- 
ance, accu-  I 
facy,  and 
pfeciiioo.   I 

Strength, 
rhythm, 

and 
halance. 
Strength, 
bttlance, 

and 
rhythm. 

I 
Agility,  Iwi-  I 
^Qce,  and 
strength,     j 


'6-30.  !  An  extreme  te.t  on 
■    the  heart. 


■  Thiifhs  .ind  legs  ex- 
erctsed  lirinci(xi||y 
during  ai.pr,«i-h 
an<)  hnishuf  move- 

I    meni. 


ifi-jo. 


'6-30. 


Exirem 


Slight. 


Ladders. 


Medidne 
ball. 


Parallel 
ban. 


Spring- 
boards. 
Trapeie. 


Tumbling, 


'■  Flexors  of   fingcra. 

wrist,  forearm 

I     am,  pectorals. 

ana  latissim-is  1 
'    dorsi. 

All  of  forearm,  arm 
shoulders,  back 
abdomen,  and 
chest. 

All  of  forearm,  arm. 
siiiHjIders,  jiccio- 
rals,  abdomen.and 
latissimus  dorsi. 


Slight. 


Balance,    . 
acturaiy,    '- 
rhythm, 
"COity,  and 
,    strength. 

Sli([hl.         Strength. 


S^ttht.  sJighi. 


Ail  of    thighs,  legs, 
and  lower  b:irk. 

l-lMors  <rf  hand, 
wnst,  forearm,  and 
am;  all  of  shoiil- 
dera-  the  aWom- 
■nals.  and  latis- 
simus  dorsi. 
The  whole  muscu- 
'ar    sysie^^ 

dally    legs,    back. 

and  neck.  1 


Strength. 

and 
accucicy. 

Modcr.ile.     Strength, 
Iwdancc, 
I    accuracy, 
and  rhythm. 


dreit. 
Kxtreme.    Moderate. 


■^i'-lerate.  .Agility  ami 
accuracy. 
Balance 
M„nyb, 

accuracy. 


Extreme.       (:;re:it. 


Rhythm, 

agility, 

strength, 

balance,  and 

,    accuracy.    1 


j  These  excrdses  .tre 
vaulting  and  lea|>- 
'««.  and  so  de- 
velop thighs  and 
legs  more  than  side 
horse, 

I  highs  and  legs  de- 
^■eioped  in  the  ap- 
proach and  finish, 
but  much  less  than 
arms    and    shoul- 


=     An    excellent    cxer- 
uRcfor  developing 
all    muscles    above 
[    the  pelvis. 
1-    Influence     w,      co- 
ordination >lei«nds 
greatly  on  the  in- 
I     Incucy  of  the  excr- 
ases  practiseil. 

■  'Me  set  of  exertises 
are  for  equilibrium 
I  ,'.™>;,  another  are 
like  the  typical  hori 
zpnlal  fKir  exer- 
nses  in  their  t-ffrct. 
One  ,4  the  bcsl  all- 
around  exercises. 


i 


I30 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


V 


Here,  again,  it  must  be  borne  in  mind  that,  in  addition  to  the 
circles  on  the  horizontal  bar,  the  swinging  exercises  on  the  flying 
rings,  vaults  on  the  horse,  and  balancing  exercises  on  the  parallel 
bars,  the  same  exercise  may  be  interchangeable  from  one  piece 
to  another. 

For  the  healthy  boy  or  girl  of  eighteen  or  thereabouts  the  best 
development  would  be  obtained  by  a  judicious  mixture  of  gymnastic 
and  athletic  exercise  in  the  open  air. 

.\  course  should  be  designed  so  as  to  employ  all  the  activities 
of  the  muscular  system — strength,  accuracy,  speed,  agility,  and 
endurance — as  naturally  as  possible. 

.\  periwl  of  gymnastic  exercise  should  begin  with  a  ten-minute 
drill,  including  movements  for  both  arms  and  legs,  with  special 
emphasis  on  correct  carriage  of  the  body  and  on  deep  breathing. 
This  should  be  followed  by,  exercises  in  rope  climbing,  on  the 
parallel  bars,  horizontal  bar,  or  flying  rings,  in  which  the  arms  are 
used ;  following  this,  exercises  of  agility,  like  vaulting  over  bars  or 
the  German  horse,  and  simple  ground  tumbling.  Each  lesson 
should  conclude  with  running  or  with  a  gymnpstic  running  game  of 
sufficient  speed  to  test  the  endurance.  The  period  sb""ld  occupy 
one-half  to  three-quarters  of  an  hour,  and  should  be  repcied  at 
least  three  times  a  week.  If  alternated  with  walks  or  out-of-door 
games,  the  maximum  development  and  general  education  o!  the 
physical  powers  should  be  obtained.  The  mental  exhilaration  ari  - 
ing  from  the  emulation  and  competition  that  is  found  in  a  large 
class  is  an  influence  by  no  means  to  be  neglected,  especially  in  the 
young,  although  exercise  will  have  its  effect  whether  this  be  pres- 
ent or  not,  just  as  surely  as  iron  or  castor  oil. 

For  those  of  mature  age  and  a  sedentary  life,  exercise  should 
be  directed  principally  to  the  muscles  of  the  arms  and  trunk,  care 
being  taken  not  to  overtax  the  circulation.  Such  exercises  as 
throwing  the  medicine  ball, — a  large  ball  weighing  from  seven  to 
twelve  pounds, — hand-ball,  and  other  ball  games,  combined  with 
simple  apparatus  work,  are  usually  effective  and  interesting.  If 
combined  with  the  fresh  air  obtained  in  a  game  like  golf,  tennis, 
or  a  brisk  walk  in  the  country  once  or  twice  a  week,  the  result 


AOE,   SEX,   AND  OCCIPATION  ,,, 

b^omTt  ■  °' "''""""«  >•'■""  "«-•  "^■^«^»»ity  for  exercise 

spo":'=:::';:;^-:it£-^-^~we.r 

tion  of  life-  ^  ixtrcii*  for  the  i)rolonga- 

once  or  t«,ce  a  day.  and  have  Rraduaily  increased  the  exercises  to 
ten  mmutes  or  a  quarter  of  an  hour.     The  deuth  of  L!-h  i 

lo„     1  •     ■        .  ""^^  ''*'^''  act  may  be  graduallv  Dro 

and  raise  the  body  several  times  during  the  exniration      Rv  ,K- 
a  ternate  bending  and  raising  of  the  body  we  c  nrmlT^tren:.  'en 

.ti:?::c^rr"'  '"^^-^  ''■■^'  ™fVUzt 

"Another  useful  combination  with  the  respiratory  exercises 

diterna  ely,  „,th  deep  msppr.tions,  from  left  to  right  and  wi.h 
exp,rat.ons,  from  right  to  left,  the  arms  being  h  ff  Ls^d  t 
th.s  movernent  we  bring  into  action  some  of  'he  muL'"  of  thl 
pme  which  are  apt  to  be  only  imperfectly  used  by  mo  pers^S 
n  advanced  years,  and  the  stiffness  of  the  neck  and  spi^  TZhe 
tendency  to  stooping,  so  common  in  old  persons,  can  b  'to  Ime 
degree  corrected  by  this  kind  of  movement.  I  commelc^Tn 
good  time  and  practised  regularly  and  thoroughly,  s"^  t  e 


'3> 


EXERnSE   IN    Eni'CATION    AND   UEDICINE 


arms  around  the  »houtder-jojnt  is  likewise  useful,  and  other 
combinations  with  muscle  and  joint  movements  will  occur,  but 
they  should  have  accustomed  themselves  to  these  respiratory 
movements.  The  latter  ouRht  always  to  have  our  principal  atten- 
tion, since  to  them  the  lienelicial  effect  on  the  heart  and  lunj^s  is 
mainly  due.  In  addition  to  the  influence  on  the  circulation,  the 
respiratory  movements  keep  up  the  nutrition  ami  efficiency  of 
the  lungs,  which  undergo  in  old  age  a  kind  of  atrophy.  The  walls 
of  the  smallest  divisions  and  air-rells  become  thinner,  and  a  kind 
of  senile  emphysema  is  develo|)ed,  which,  by  this  exercise,  is  to 
some  degree  prevented. 

"Another  im|X)rtant  influence  consists  in  maintaining  the 
elasticity  of  the  chest-walls,  which  are  apt  to  become  stiff  in  old 
age,  and  thus  to  interfere  with  free  movements  of  the  lungs  and  the 
pleura.  If,  for  some  reason. i  the  erect  |)Osition  should  be  incon- 
venient, respiratory  movements  can  be  made  also  in  the  horizontal 
and  sitting  positions." 

In  addition  to  these  exercises,  taken  regularly  every  morning, 
he  strongly  advises  a  walk  lasting  from  a  half  to  three  hours,  part 
to  be  taken  in  the  morning  and  part  later  in  the  day,  and  once  a 
week  he  recommends  a  day  of  more  prolonged  exercise,  and  a 
holiday  once  or  twice  a  year  spent  in  a  walking  or  climbing  tour 
of  three  or  four  weeks. 

Occupation  should  have  equal  weight  with  age  in  choosing 
exercise.  In  the  natural  occupations  of  man,  like  farming,  fishing, 
and  lumbering,  a  great  deal  of  muscular  exertion  in  the  open  air  is 
required,  and  the  need  for  it  is  thus  naturally  provided  for. 
During  the  last  hundred  years,  however,  the  ])ro|)ortion  of  city 
dwellers  has  risen  from  2  to  nearly  60  per  cent.,  and  the  artificial 
and  confining  conditions  of  a  crowded  city  life  must  be  faced. 
The  segregation  of  masses  of  people  limits  the  amount  of  space 
and  air  for  each,  and  the  necessity  of  further  economizing 
energy  by  the  use  of  machinery  reduces  muscular  activity  to  a 
mini  am.  This  ap))lies  especially  to  the  most  "civilized"  part 
of  a  civilized  community,  so  that  there  has  arisen  a  whole 
series  of   defects  and   diseases   due   to   this  suppression  of  the 


ACE,   SEX,   A.ND  OCCUPATION 


>jj 


natural  muscular  activity,  or  to  its  concentration  on  a  few  move- 
menu. 

School-children  are  taken  for  live  hours  a  .lay  from  their 
natural  occupation  of  out.loor  play  an.l  confmt.l  more  or  less 
strictly  to  a  sittinK  or  standing  jxnition,  makin;-  their  Uxlies  fertile 
soil  for  the  growth  and  .levelopment  of  |K«tural  defects.  It  is 
necessary  then,  that  exercise  in  the  of^n  air  for  city  children  of 
he  .school  age  shoul.l  Ik'  ol.taine.1,  by  playgroumls,  situated  in 
ttie  more  congested  districts. 

The  construction  of  roof  ganlens,  recreation  piers,  an.l  other 
otK;n.air  breathing  spaces  is  also  .iirecte.!  by  this  same  nee.1,  an.l 
the  gymnastic  exercises  for  school-children  <lescritK..I  in  .letail  in  a 
subsc..juent  chapter  are  .lesigne.1  primarily  for  correcting  the 
physical  deterioration  inevitably  associate.1  with  confmcl  school 

The  dilTerencc  between  the  physical  life  of  a  factory  employee 
who  tends  a  machine,  an.l  of  a  man  whose  active  life  is  s.K-nt  on 
the  farii,  or  in  a  lumber  camp,  is  at  once  apparent,  but  even 
among  business  men  the  effect  of  un.lerexercise  an.l  overeating 
IS  familiar  to  the  physician,  whom  he  consults  for  his  constipation 
biliousness,  and  headache,  while  the  increase  in  nervous  disorders 
m  both  men  and  women  of  a  highly  civilize.1  community  shows  the 
disastrou.,  effects  of  city  life  on  the  overstimulate.1  nervous  ..ystem 
Among  the  influences  that  help  to  pro,luce  these  conditions  are 
the  ease  of  intercommunication  by  mail,  telephone,  and  telegraph 
By  these  means  alone  a  man  may  double  or  treble  the  amount  of 
business  done  before  their  use,  but  ft  an  added  nervous  exr^n.li- 
ture.     The  constant  harrowing  of  the  emotions  by   the   press 
with  Its  daily  tale  of  horror,  is  a  morbid  addition  to  hi;  load         '  ' 
Those  who  live  the  confined  indoor  life  of  the  office  or  study 
overtaxing  the  brain  and  slighting  the  muscular  system,  would 
derive  benefit  from  any  exercise  sufficiently  vigorous  to  stimulate 
the  circulation  and  the  skin.     It  is  to  such  men  that  the  corres- 
pondence  schools   described  in  the   previous   chapter   are   most 
alluring,  with  their  promises  of  incredible  results  from  the  modest 
expenditure  of  a  few  moments  daily,  while  the  secrecy  with  which 


•34 


KXMCME  IN   EDl'CATION  AND  IIEDICINi: 


thiy  arc  shrouded  and  the  hixh  price  demanded  for  inHtnictions 
■dd  not  a  lililc  to  their  allurement. 

The  design  of  a  short  course  of  exercises  without  a|>|)antus 
for  the  average  business  man  of  mature  age  and  sound  constitu- 
tion has  lieen  undertaken  by  D  .  Luther  Gulick,  in  his  "Ten 
Minutes'  Exercise  for  the  Busy  Man,"  and  by  J.  P.  Mullcr,  of 
Klampenborg,  Denmark,  in  his  "Fifteen  Minutes'  Work  a  Day 
for  Health's  Sake,"  where  the  first  eight  movements  terminate 
in  a  bath  and  are  followed  by  ten  exercises  n  self-massage,  and 
the  following  list  has  Ijecn  compiled  and  foiiml  of  prove<l  value 
by  the  author,  for  those  to  whom  the  more  interesting  and 
varied  but  time-consuming  exercises  and  games  are  prohibited 
by  cir'  umstances.  These  exercises  may  lie  done  in  the  morning  on 
riviig  or  late  in  the  afternoon,  before  dinner,  and  should  occupy 
aljout  fifteen  minutes. 

They  aim  to  stretch  the  thorax  and  expand  the  lungs,  to  give 
the  heart  some  vigorous  worii,  and  to  agitate  and  massage  the 
abdominal  organs,  but  one  should  begin  gradually,  take  long 
rests,  and  use  few  movements  at  first. 

Exercise  i.— Position:  Standing; 
arms  at  sides,  chin  to  neck,  abdo- 
men in,  and  chcsl  c'  ied  well  ior- 
ward  without  contracting  the  shoulder 
muscles. 

Movement:  Arms  forward  raise, 
palms  down,  upward  stretch,  rise  on 
tip-toe  (Fig.  87),  inhale.  Sideways 
low(  palms  back,  keeping  arms 
straight,  slowly  exhale  and  lower 
heels.     Repeal  twenty  limes. 

Exercise    2. — Position:    Standing, 
arms  behind  back,  hands  resting  in 
small    of    back,  fingers    interlocked, 
with  palms  facing  backward  (Fig.  88). 
Straighten  arms,  turning  palms  in,  then  down 
and  then  out,  keeping  fingers  interlocked.    Roll  shoulders  and 


Fig.  «7. 

Movements; 


Fig.  8«. 


AOK,  g|:x,   AND  (KX-l  MT«>S 


»3S 


.rn»  into  ,upin..ion;  cxicn.l  nc-ck  (FIk.  8g,.     Holrl  .his  ..W.ion 

for  a  m„„em  and  then  rcver.  nbuly  Uck  ...  „ar.i„«  ,Li.i„„. 

:V<«r.-Wh,,,  the  lingers  cannot  !«  kq.t  in  thi*  ,K>»iiion,  start 

by  holilinK  a  loo|.  of  cord  in  the  hands 

instead  of  intcrlockinR  the  lingers.     Re- 

pral  turnly  limes. 


n»- ««. 


n«-  90. 


Extrcis,  j.-Position:    Lying  on  back,  hands  on  hii« 

i,  tourT'^L'*'"''*  '""'  """''  """"""'y  "'■"'  '«^^'"  "^n-  'ill 
L  L  "  "'\'L'!^'""'"-  ^l^^P  »«"«'«  around  leg,  and  press  in  on 
theaMomen  (Fig.  90).     Relax.     R,pea,  l^rnly  limes. 

i..Vfr<:(j<- 4._Position:  Stand- 
ing, hands  behind  head. 

Movements;  Bend  siflew,iy, 
to  right,  then  forward,  then  to 
left  (Fig.  gi),  and  then  back- 
ward, circling  five  times  each 
way.  Keep  feet  together  and 
the  knees  straight.  Get  far 
down  on  each  side.  Repeal 
Iwenly  limes. 

Exercise  5.— Position :  Stand- 
ing, hands  clasped  behind  head 
(Fig.  93). 

Movement:   Force  the  head  and  elbows  back  strongly.    Relax 
lettmg  the  elbows  come  forward.     Repeal  Iwnly  lim.' 
Exercise  6.— Legs  thirty  inches  apart,  arms  at  s.    -. 
Movement:    Raise  arms  above  head,  bend  forward  and  touch 


Fig.  91 


Fig.  9a. 


n 


I 


136 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


floor  with  both  hands  (Fig.  93).     Rise  slowly  and  bring  hands 
to  position.     Repeat  twenty  times. 

Exercise  7.— Position:    Arms  forward  (Fig.  94),  then  out  and 
then  up,  stationary  run. 


fig-  93- 


Fig.  94. — Stationary  running. 


Fig-  95- 


Movement:    M    the    rate   of   fifteen   steps   in   five   seconds. 
Take  fifty  steps  for  each  position  of  the  arms. 

Exercise  8. — Position :  Standing,  hands  clasped  across  abdomen. 
Movement:     Inhale,    pressing   in   abdominal  wall  (Fig.  95). 
Exhale,  relaxing  abdomen.     Repeat  twenty  times. 

Exercise  9.— Position:    Sitting  on   stool  or  on  side  of  bed, 
hands  clasped  behind  the  back. 

Movement:  Trunk  rolling,  forward  to  right;  backward  and 
then  to  left  (Fig.  96) ;  then  up  to  start- 
ing position.     Repeat  twenty  limes. 

Exercise     10. — Position:       /°^ 
Standing.  1       \ 

Movement:   Arms  side-     /i5^ 
ways,  raise,  upward  stretch, 
inhale.    Forward  bend  (Fig. 
97)   and  rise.      ,\rms  side- 
ways lower.     Exhale. 
To  Finish. — Wring  out  a  Turkish  towel  in  odd  water.     Take 
it  by  both  ends  and  rub  hard  back,  chest,  abdomen  itnd  thighs. 


Fig.  96. 


Fig.  97. 


CHAPTER   IX 
PLAYGROUNDS  AND  MUNICIPAL  GYMNASIUMS 

The  segregation  of  city  life,  with  its  attending  evils,  weighs 
most  heav,ly  on  the  children  of  all  but  the  very  rich    and  the 
surv,val  of  a  strong  and  healthy  race  depends  on  pLid  ng  b" L  h 
ing  spaces  and  free  play  for  them  ^ 

:;o^:^for;c. ' ' "'"'  "''^^^^  ""■ "  -"  '^^  ^-^^  ^--— 

In  New  York,  according  to  the  statistics  of  ,900,  about  «oo 
persons  hved  on  one  city  block,  in  about  rjoo  roomT;oo  of  wh  c" 
had  no  w,ndows  and  no  outside  doors.  The  commiu^  on  ptv 
ground  organ-nation  made  a  map  of  the  city,  show.ng  the  r5s 
and  playgrounds  by  green  squares.  Then  they  called  in  Se 
cap ta,ns  from  different  districts,  and  asked  them  to  fx^in  ouMhe 
parts  where  restless  boys  gave  the  most  trouble.     In  evl^y  case 

parks,  or  trees.  The  committee  then  put  a  red  sign  on  each  of 
Oiese  troublesome  places.  Other  policemen,  who  said  , hi  , he 
boys  gav-e  them  no  trouble,  pointed  to  their  districts,  which  I  le 
always  close  to  the  parks.  The  committee  ne«  stucL  pins  in  the 
map  o  show  w.here  the  schools  were  and  where  the  chilXen  v 
thickest  This  map  was  sent  to  the  Mayor,  and  with  it  a  copy  of 
the  State  law    which  reads:     -'Hereafter  no  school-houses  fhd 

£  umrsTe.""^ " "- '-'  -"-  ^'---- 


'38 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


Wherever  the  pins  were  thickest  on  the  ma)),  showing  the 
most  children,  the  red  signs  were  thickest  too,  and  it  has  since  been 
proved  that  the  putting  of  green  spots  into  these  regions  will  drive 

the  red  spots  out. 

This  was  a  graphic 
method  of  showing  the  in- 
fluence of  play  on  juvenile 
crime,  so  much  of  which  is 
due  to  lack  of  a  proper  out- 
let for  the  natural  impulses 
and  instincts  of  the  healthy 
child. 

So  long  as  the  surround- 
ings are  normal  for  the  best 
development  of  a  child's 
neuromuscular  system,  the 
choice  of  play  and  its  con- 
duct may  be  left  to  the 
natural  instincts  of  the  child, 
but  in  a  city  these  normal 
instincts  are  thwarted,  and 
if  exercised  at  all,  his  games 
of  ball  or  tag,  his  hunting 
and  fighting  games,  bring 
him  into  conflict  with  the 
police,  and  land  him  in  the 
juvenile  court,  accused  of 
such  crimes  as  destruction 
of  property,  disorderly  con- 
duct, and  burglary. 

One    of    the     strongest 

pleas  for  the  establishment 

of  playgrounds  is  made  from 

this  social  side  rather  than 

from  that  of  physical  education  proper.     It  was   proved   that 

juvenile    crime    decreased   over   60   per   cent,    in  each   district 


Fig,  98. — City  conditions  showing  need  of 
playgrounds  (Playgrounds  Association  of  Phil- 
adelphia). 


PLAYGEOLNDS  AND  MUNICIPAL 


GYMNASIIMS 


Fig. 


19 -A  typical  east  side  .tree,  in  New  Yorli  city. 

Where  .he   H,ht  .o  p,a,  and  a  „.ace  .o  p,a,  .as  «.v. 


given  to  the 


Fig.   too.— A; 


■mprovised  sho,„.b.,h  (PUyg™.„d.  A«„iati„„  o,  PhiMelphi.,. 


i 

il-  I! 


r  I 
II 


I40 


EXERCISE   IN    EDUCATION   AND   MEDICINE 


In  the  ])oor  and  crowded  districts  ^f  the  city  the  condition  of 
the  homes  is  such  as  to  make  free  play  impossible;  the  children 
have  not  even  room  or  opportunity  to  run  or  bathe,  and  the  city 
must  provide  them  with  both. 

The  necessity  of  teaching  the  language  and  tne  ideals  of  their 
adopted  country  to  the  hordes  of  foreigners  who  yearly  immigrate 
to  such  cities  as  Chicago  or  New  York  make  the  playgrounds  and 


municipal  gymnasiums  a  most  valuable  means  of  education,  and 
the  experience  of  Chicago  among  the  Bohemians,  Lithuanians, 
and  Poles  has  been  such  as  thoroughly  to  justify  the  large  annual 
expenditure. 

The  introduction  of  playgrounds  in  American  cities  has 
usually  been  the  voluntary  labor  of  private  committees,  cooperating 
with  the  school  boards,  obtaining  the  use  of  certain  school  yards 
and  open  spaces  by  donation  or  purchase,  equipoing  them,  and 


PLAYGROLN-nS   AND   MUNICIPAL   GYMNASIUMS 


141 


demonstrating  their  usefulness  to  the  city,  an^l  so  bringing  on  tlie 
council  the  influence  of  the  people  directly  benefited,  and  finally 


securing  purchase  of  the  ground  and  permanent  supervision  by 
the  municipal'ty. 

Playgr-^unds  should  be  of  three  distinct  tyi,es^smal!,  mclium 
and  large.  ' 


142 


EXERCISE   IS   EDl'CATION   AND   MEDICINE 


lii 


Type  /.—Numerous  small  pieces  of  ground  are  usually  obtain- 
able by  utilizing  vacant  lots.  These  can  be  transformed  into 
playgrounds  for  small  children  of  both  sexes,  and  should  be 
equipped  with  a  few  small  swings,  see-saws,  a  sand  pile  under  a 
canvas  awning,  toilet  facilities,  and  a  shelter  for  rainy  weather. 
If  ix)ssiblc,  a  shallow  wading  pool  wi.h  sand  or  concrete  bottom 
should  be  provided. 

T"ie  expense  of  sucli  an  equipment  need  not  exceed  fifty 
dollars,  distributed  somewhat  as  follows: 

I.  Ten-foot  double  swing  frame 
with  triangular  ends,  braced,  and 
two  swing.s— ten  to  twenty-five 
dollars. 
'  2.  Children's  six-foot  swings, 
with  canvas  scups  for  little  chil- 
dren to  swing  or  sleep  in,  well 
protected  from  the  sun— ten  to 
thirty-five  dollars.     (See  Fig.  103.) 

3.  Two  or  three  see-saws  with 
14-foot  boards,  at  five  to  ten 
dollars  each. 

4.  Sand-box,  varying  in  size 
and  shape  according  to  the  space, 
filled  by  one  or  two  loads  of  fine 
white  sand— five  to  fourteen  dollars. 

5.  .\vvning  for  protection  against 
the  midday  sun  and  shelter  for 
rainy  weather— ten  to  sixty  dollars. 

There  should   also  be  connec- 
tion with   the  water-supply  of   the 
city. 
Much  of  the  equipment  is  frequently  obtained  from  interested 
supporters  of  the  movement. 

The  back  yard  may  be  turned  into  a  playground  of  this  kind, 
as  has  been  done  in  Philadelphia  by  Dr.  Talcott  Williams  and 
others.     The  arrangement  of  apparatus  would  be  as  in  Fig.  104. 


^■ig-  103- — Construction  of  a  swing  for 
little  children  in  the  playground. 


PLAVOHOUNDS   AND   UIN.CIPAL   GVM.NA.SU  MS 


143 


these  .mali  playgrounds,  but  they  should  be  scattcrl/alu,  at 


d  stances  o  not  more  than  three  or  four  blocks  from  the  homes 
of  the  children  who  have  to  use  them.  Small  children  cann!^ 
go  more  than  a  few  hundred  yards  to  their  playground ^a^d  fo 


m 


144 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


m 


I 


that  reason  the  city  parks  are  unavailable  except  on  a  holiday  o, 
other  great  occasion. 

Type  //.—The  second  ty|)c  of  playground  should  consist  of  a 
piece  of  ground,  from  two  to  ten  acres,  with  a  more  substantial 
shelter,  containing  toilet-rooms,  shower-baths,  and  an  office  for  the 
supervisor.  The  ground  itself  should  be  provided  with  a  wad- 
ing pool,  a  .sand  pile,  or  court  for  young  children,  and  a  swim- 
ming pool  for  those  who  are  older. 


OS-— Type  I  of  playground  (Elizabeth  Rafter). 


The  sand  ])ilc  here  may  be  extended  to  the  dignity  of  a  ganlen 
or  court,  fenced  in.  and  provided  with  simple  toys,  buckets,  shovels, 
and  building  bIock^.  These  are  frequently  carried  off,  but  this 
was  prevented  in  one  playground  by  an  effective  checking  system. 
The  child  wanting  a  pail  or  shovel  deposited  his  hat,  which  was 
returned  when  he  returned  the  tools.  The  sand  should  be  eximsed 
to  the  sun  and  rain,  and  great  care  should  be  exercised  to  prevent 
the  spread  of  communicable  diseases  through  this  medium. 


PlAVC.«0,-.Nns   AN,,  „,.N,c,p,,  ovMNASIUMS 


'45 


:  y^'iV^Mmfi  ;v.t,^. 


'I 


r 


Fis-  .o6._A  wading  pool  in  lairmounl  P,„ 


$^t:*-' 


LUmi 


Fi,.  ,o;.-SanH  pile  (W.,e„iew  Park,  G.™.„,o„„,  p,  , 


it 

H 

Im 

1  ^ 

^H 

him 

1 

1 

u 

146 


EXEBCISE  IN  EOl'CAnON  AND  MEDICINE 


Tig-  loR.^An  up-(o~ditte  playjirouncl  rqulpmrnt  for  M-iund  ty]>r  ol  playKround. 

is  large  enough,  there  should  be  a  running  track  surrounding  the 
field.     These  playgrounds  aire  necessarily  fewer  in  number  than 


Fig.    left). — .Apparatus  in  use  ((iymna^iium,  Washington  Park,  Pittsbunfh}. 


the  first,  but  should  not  be  more  than  half  a  mile  apart  in  the 
crowded  sections  of  the  city.     They  are  intended  for  boys  and 


mVO«ot»DS  AND  «™,C,P«  CVMNASIUM.  „, 


148 


KXfcRClSK    IN    KOt'CATlON    AM)   MKimiNK 


Typ*'  Ill.—'Vhv  third  tyi>c  i>f  pluy^nniml  should  In;  found  in 
the  outskirts  of  the  city,  usuully  conntxtcd  with  the  park  system. 
These  playing  fields,  like  Boston  Common  or  Belmont  Plateau  in 
I*hiladelphia,  should  lie  of  such  si/c  as  to  allow  of  two  huselmll 


FiK-  til- — I.urKC  municipal  playitruund  plan  (Elizalivth  Rafirr). 


diamonds  or  foot-l)all  fields,  a  (|uarter-mile  running  track,  the  out- 
door apparatus  described  in  the  second  type,  and  a  large  gym- 
nasium hall  and  dressing  rooms. 

municipality  and  have  the  necessary  (i>nvenienri-s  already  installed,  with  the 
I><>ssit)ility  of  using  the  Ijusemt-nt  in  rainy  weather.  The  yards  arc  already 
endosed  and  the  janitors  can  look  after  the  apparatus  when  the  ground  is  not 
in  use  hy  the  children,  thus  preventing  the  wanton  destruction  of  pr«»i»erty 
that  is  s*>  frequent.  The  field  apparatus  can  also  1*  used  all  year  and  not  in 
the  summer  only,  and  the  cost  of  administration  is  thus  greatly  lessened. 

If  the  school  yards  are  used,  Utards  of  education  are  encouraged  to  huy  neigh- 
iKiring  property  tn  enlarge  them,  as  has  already  been  done  in  Philadelphia  antl 
elsewhere,  and  both  municipality  and  schtxvl  lx)ard  profit  from  the  combination. 


PIAYOROUNDS   AND   MIMCIPAL   IJYM.NA8I11IS 


MO 


*;| 


11! 


15° 


EXE8CISE  IN  EDUCATION  AND  MEDICINE 


In  the  building  there  should  be  shower  baths,  and  close  by  a 
swimming  pool  with  deep  aiid  shallow  divisions,  and  also  a  wading 
pool  for  the  small  children  and  girls.  In  some  cities,  notably  in 
Chicago,  this  type  of  playground  has  been  made  a  social  center, 
the  permanent  building  containing  a  large  auditorium  for  lectures 
and  various  social  gatherings  of  the  people  of  the  quarter.  Every 
attempt  is  made  to  encourage  these  gatherings,  as  well  as  the 
specific  physical  training  for  which  these  playgrounds  were  origin- 
ally designed. 

Play  in  itself  is  essentially  neither  good  nor  bad,  but  it  has 
great  possibilities  for  good  in  the  hands  of  a  capable  director, 
and  the  profession  of  playground  supervisor  is  a  distinct  specialty 
in  physical  education,  requirtag  unusual  natural  gifts  and  careful 
preparation. 

The  supervisor  of  the  smaller  playgrounds  for  young  children 
should  be  familiar  with  kindergarten  methods:  she  should  teach 
them  the  simple  kindergarten  games  and  direct  them  in  their 
play  in  the  sand  heap,  having  story-telling  hours  and  other  occupa- 
tions most  interesting  to  children  of  that  age.  This  may  well  be 
combined  with  visiting  the  children's  homes  and  tactfully  instilling 
in  the  parent's  minds  the  importance  of  cleanliness  and  personal 
hygiene. 

The  larger  playgrounds  require  a  man  to  give  at  regular  hours 
a  definite  amount  of  gymnastic  exercise  in  the  form  of  marches, 
setting-up  drills,  and  apparatus  work.  He  should  organize  gym- 
nastic and  athletic  games,  of  which  there  are  many  specially 
designed  to  be  played  by  a  large  number  of  players  in  a  small 
space.  DeGroot's  playground  ball  is  popular  with  the  boys  of 
Chicago,  and  ideally  suited  for  these  conditions.  He  should  ilso 
organize  among  the  boys  athletic  contests  and  games  extending  to 
interplayground  contests,  in  which  loyalty  to  their  section  or  even 
to  their  city  is  taught,  and  the  spirit  of  fair  pUy  and  clean  sport 
is  instilled  in  their  youthful  minds. 

A  period  of  exercise  should  begin  with  marching,  light  setting-up 
movements,  and  then  exercises  on  the  fixed  apparatus,  in  which 
the  possibilities  of  each  piece  are  shown.    .\s  a  rule,  less  emphasis 


PtAVGROUNDS  AND   MMICIPAI,  GYMNASIUMS  iji 

is  laid  on  the  form  in  which  a  feat  is  accomplished  than  indoors 
The  apparatus  IS  considered  much  more  casually 

This  should  be  followed  by  an  athletic  game  or  contest   like 
the  wheelbarrow  race,  run  by  two  boys,  one  grasping  the  aniles 


of  h^  companion,  who  runs  forward  on  his  hands;  the  three 
legg«i  race;  obstacle  races;  relays;  jumping  and  vaulti'ng  Ld  ^e 
of  the  many  games  with  the  basket-baU  or  medicine  balL 


El 
V  ' 


•52 


EXERCISE   IN    EDUCATION   AND   MEDICINE 


The  wading  ikmI  can  be  systematically  used  for  games  of  tag, 
leap-frog,  tub-racing,  and  the  like,  the  children,  of  course,  being 
suitably  dressed  or,  rather,  undressed.  Of  these  sports  children 
never  tire  and  the  spectators  are  entertained  not  a  little. 

Many  children  learn  to  swim  instinctively  or  arc  taught  by 
companions,  but  the  teaching  of  swimming  should  be  part  of  the 
playground  activity,  and  games  of  water  polo  and  water  basket-ball, 
as  designed  by  Dr.  A.  E.  Garland,  of  Boston,  arc  much  in  vogue. 

Certain  days  should  be  set  apart  for  girls  if  they  cannot  have 
their  own  pool,  but  the  playground  instruction  for  them  would 
differ  in  certain  important  particulars  from  the  course  most  suitable 
for  boys. 

The  round  games  are  alvvays  popular  with  them,  especially 
singing  and  marching,  the  salute  to  the  flag,  and,  above  all,  dancing. 
Most  of  the  European  races  are  rich  in  folk-dancing,  and  the 
exhibitions  of  these  dances  of  Scotland,  Sweden,  Russia,  Spain, 
and  Bohemia  at  the  playground  congresses  have  alvvays  attracted 
deep  interest.  From  such  sources  American  folk-dancing  is  being 
evolved.  The  contra  danses  of  .America,  English  in  origin,  are 
widely  used  as  quadrilles,  and  the  Sir  Roger  de  Coverly,  or  Virginia 
reel,  with  modern  embellishments,  is  always  popular.  Dancing 
has  almost  entirely  replaced  athletic  contests  in  the  girl's  branch 
of  the  Public  School  Athletic  League  of  New  York,  with  the 
greatest  advantage. 

Here,  again,  is  shown  the  necessity  for  special  training  of 
teachers  who  are  to  take  up  this  profession  of  playground  super- 
visor. 

Where  playgrounds  cannot  be  otherwise  obtained,  the  school 
playgrounds  are  used  with  great  advantage,  both  for  the  first  and 
second  grades,  as  already  described,  and  the  regular  school-teachers 
are  frequently  employed  as  supervisors  after  a  course  of  training 
to  fit  them  for  this  specialty. 

The  need  for  playgrounds  and  breathing  spaces  in  the  crowded 
wards  of  ihe  great  cities  jumps  to  the  eye,  but  it  also  exists  in  the 
country  village,  the  town,  and  in  those  parts  of  a  city  where  poverty 
is  unknown.     While  the  usual  attack  on  the  problem  is  made  by 


PLAYCHOLNDS   AND  MUNICIPAL   GYMNASIUMS  .53 

Ifterward'th?"'  "'.'l'-^'"™""*  ''-'.  -"  Mymnasiums  and  baths 
afte  vvar,l,  the  provision  of  systematic  exercise  for  city  resi.lent, 
has  ,«.en  approached  in  the  reverse  way,  in  at  leas,  one  city  lot 
the  slum  is  non-exisfant  n„,\  ,u  ■      ■        '"- "-'V'  nncrc 

wealthy.  community  is  prosperous  and 

for  Jcl^he'l.h'  "r"-"'''  •''''^-^•'"-'"^.  '-K-  the  campaign 
equipped  with  showers,  dressing-rooms,  and  a  large  swimming 


Fi«.  M4.-Th...  „,!„  „erd„  hall  „,  ,he  B^Une  .„„ici,:;^IZ!rZr 

E  in^'tho  ^'™'"T  '■"  r'"""''"«  ^™^  «''^-  '°  --'ents  of  the 


ifi 


»S4 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


windows  and  skylight,  making  a  height  of  forty-five  feet  in  the 
center. 

This  hall  is  equipped  with  a  complete  outfit  of  gymnastic 
apparatus,  and  contains  a  running  track,  also  used  as  a  gallery  for 
spectators  at  the  exhibitions.  The  climbing  and  fixed  apparatus 
are  in  sets  of  four,  arranged  so  that  the  floor  may  be  rapidly  cleared. 

A  small  gymnasium,  74  feet  by  34  feet,  having  a  height  of 
32  feet,  is  equipped  with  Swedish  apparatus,  and  is  used  for  the 
overflow  from  the  children's  classes. 


Fig.  115.— The  small  aerdlc  hall  of  the  Brookline  municipal  gymnasium  and  baths. 

There  are  special  rooms  on  the  fourth  floor  and  in  the  basement 
for  private  instruction  and  for  games  and  corrective  apparatus. 

All  the  regular  classes  in  the  gymnasium  are  free  to  residents 
of  Brookline  and  non-residents  are  admitted  on  the  payment  of  a 
fee.  Preliminary  medical  examination,  while  not  obligatory,  is 
strongly  recommended. 

The  schedule  of  classes  in  the  annual  report  of  Mr.  J.  Leonard 
Mason,  the  director,  shows  the  scope  and  variety  of  a  week's  work: 


PLAVOROUNns   AN..  UV,UC1P.,L  CVMNASIUMS 

Women'.  af,emo„„  ,,.„ Mo.ndav. 

Men's  afternoon  iUm 3:45 

Men'i  erening  class 5: 15 

8:00 

Women's  morning  djs,  Tuesdav. 

GW,  under  fourteen  year,,'  .,,„„,«,„  ,„^ '<>=  3<. 

Girls  over  fourteen  years,  aftem™,„  ,H^     '■■>! 

Men  s  afternoon  class 5: 45 

Women's  ewning  class 5: 15 

Public  sch..,l  teachers'  class    '^'•""'^•'" 

Boys  under  fourteen  years,  aftern,.,„  da,. ^^  ~ 

Boys  over  fourteen  years,  afternoon  d,ss" ''^  5° 

iroung  men's  evening  class 3^45 

Women's  morning  dass Thursday. 

Women's  afternoon  dass.  'O' .?o 

Men's  afternoon  class 3:45 

Men's  evening  dass 5:15 

8;oo 

Friday. 
Gtrls  under  fourteen  , -ears,  aftem,.,„  class 

G.ris  over  fourteen  years,  afternoon  dass          "*' 

Women  s  evening  class 3:45 

8;oo 

Corrective  gymnastics ^'"™oay. 

Cliildren  under  ten  years  class       9:,io 

Boys  under  fourteen  years  class     '°-}° 

Boys  over  fourteen  years  dass. . .         '-3° 

Voung  men's  evening  class [["  ' *■ 'S 

8:00 

climbing,  and  gyLu.stic  gam  ^ClEfrr  '"  """"'■"«' 
acteristic  of  the  German  gymL.lsFn  M  ?T  """"^  '^"- 
dancing  steps  to  the  ™,.i    T  ^"''  °^  ""«  ^™«  age 

Girls  Lt'^folt:  r^e  :  aTXn  "^"^  ^"""°^^- 
Though  they  have  passed  fhrn  n  *'  *  ''P^™'^  '^'''^s- 

the  childish  plavstLTT^  '"'^"  ^"^  ''"=  -«"  '"te^csted  in 

games  ut!  ^  owS"  ""  '"  '^"""^  "  "'^  ^^  "'^  -8ged 


'55 


I 


'56 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


This  age  division  has  not  been  found  necessary  among  the 
boys,  according  to  Mr.  Mason. 

Women  from  twenty-five  to  sixty  have  their  classes  in  the  morn- 
ing, and  begin  their  lesson  with  marching,  setting-up  movements, 
and  the  hght,  graceful  calisthenics  requiring  skill;  women  of  this 
age  are  fond  of  balancing  movements  and  of  dancing,  the  slower 
rhythmic  movements  and  relaxing  exercises  being  used  with  great 
advantage.  Violent  exercises  of  jumping  and  vaulting,  in  which 
the  body  may  be  jarred,  are  avoided.  The  women's  cla.sses  are 
very  popular,  and  have  a  distinct  social  value,  which  their  members 
heartily  appreciate.  The  afternoon  class  for  women  is  attended 
by  many  school-teachers  who  arc  mentally  tired  from  their  day's 
teaching.  For  them  the  exercises  are  rhythmic  and  given  by 
imitation,  all  exercises  requiring  close  attention  by  word  of  com- 
mand are  avoided. 

The  working-girls  and  women  come  in  the  evening,  and 
require  more  strenuous  work.  They  are  fond  of  the  apparatus 
and  social  dancing  with  music. 

In  addition  to  what  may  be  called  the  routine  work  of  the 
gymnasium,  an  opportunity  is  given  for  the  practice  of  swimming, 
wrestling,  fencing,  and  gymnastics,  and  clubs  for  their  promotion 
are  organized. 

The  senior  boys  take  up  the  heavier  apparatus  work  and  indoor 
athletics,  while  the  girls  arc  instructed  in  athletics,  modified  and 
reduced,  some  litde  apparatus  work,  and  dancing.  The  strenuous 
competitive  games  like  basket-ball  are  not  encouraged,  although 
they  are  permitted. 

Business  and  professional  men,  varying  in  age  from  thirty  to 
sixty  years,  do  not  tolerate  work  in  which  close  continual  attention 
is  required.  Music  is  thus  of  special  value  to  accompany  the 
setting-up  exercise  with  which  their  class  begins,  and  simple 
rhythmic  dancing  steps  to  music  are  very  popular  with  them. 
The  movements  of  boxing  and  games,  like  indoor  baseball,  also 
appeal  to  them  strongly,  and  a  favorite  exercise  is  found  in  the 
medicine  ball  games,  which  invigorate  the  muscles  of  the  arm  and 
trunk  overstrained  or  unused  by  many  business  and  working  men. 


PLAYGROUNDS  AND  MITNICIPAL   GYMNASHMS  157 

In  a  town  like  Brookline,  of  less  than  30.000  jK^ple,  the  avcraKC 
weekly  attendance  at  the  gymnasium  during  the  first  year  was 
1473,  of  which  over  800  were  girls  and  women. 

An  outgrowth  of  the  movement  for  play  has  been  the  establish 
ment  of  summer  camps  for  city  children,  frequently  started  by 
private  benefactors,  newspapers,  or  charitable  organizations.  In 
them  provision  is  made  for  physical  training,  and  the  days  are 
spent  m  roaming  the  woo,ls  and  hills  or  on  the  water.  Large 
numbers  of  poor  children  are  thus  given  the  advantage  of  country 


Vi'"*"-?nt"/l'||' 


i'lfl      Hi  ".J 


Fig.   ..6. --Morning  gy„na,li<,  at  c.n>,,  T^cunwh  (Dr.  Onon',  „n|,). 

air  and  surroundings  in  the  hot  weather  that  is  so  fatal  to  the  chil- 
dren of  the  city. 

The  Young  Men's  Christian  .Associations  have  been  par- 
ticularly active  in  providing  camps  for  their  members,  where  they 
may  live  under  canvas  for  July  and  .\ugust,  and  private  camps 
have  been  established  by  Dr.  George  W.  Orton,  Dr.  George  L 
Meylan,  and  others  in  the  mountains  of  Maine,  New  Hamp- 
shire, and  elsewhere. 

_     In  1907  more  than  25,000  boys  were  spending  their  holidays 
in  this  way. 

In  ^dition  to  this  over  5000  boys  who  were  unable  to  afford 
the  moderate  expense  were  housed  in  the  settlement  camps. 

The  first  girls'  camp  was  started  in  1903,  and  four  years  later 
there  were  at  least  thirty  such  camps  in  operation.       ' 


ii 


CHAPTER  X 
PHYSICAL  EDUCATION  IN  SCHOOLS 

More  than  23  per  cent,  of  the  total  population  of  America 
spends  from  three  to  6ve  hours  a  day  in  school,  and  with  the 
extension  of  the  public-school  system  the  responsibility  of  educa- 
tional boards  increases  correspondingly  toward  the  growing 
number  of  children  under'  their  care. 

The  normal  life  of  a  child  during  its  waking  hours  is  one  of 
muscular  activity,  but  if  discipline  is  to  be  maintained  in  the 
school-room,  the  teacher  must  inevitably  suppress  a  greater  part 
of  this  restlessness  so  fundamentally  related  to  growth. 

The  lessening  of  natural  movements  by  school  limitations 
during  the  years  of  growth  is  harmful  not  only  because  muscular 
exercise  is  decreased,  but  because  nervous  tension  and  strain 
are  more  than  correspondingly  increased.  This  tension  sho'old  be 
repeatedly  relaxed  by  periods  of  physical  exercise  designed  with 
three  objects  in  mind— first,  to  correct  the  physical  faults  and  de- 
formities fostered  by  the  sitting  posture;  second,  to  recreate  the 
mind  and  body  of  the  child,  and,  third,  to  develop  his  physique 
along  natural  and  normal  lines. 

In  the  building  of  schools  the  sanitary  engineer  should  see  that 
every  school-room  has  15  square  feet  of  floor  space  and  300  cubic 
feet  of  air  for  each  pupil,  and  a  system  of  ventilation  capable  of 
supplying  him  with  30  cubic  feet  of  pure  air  every  minute.  It  is 
his  duty  to  see  that  the  light  is  abundant,  the  window  area  about 
one-fifth  of  the  floor  space,  and  arranged  to  come  from  behind  or 
over  the  Iqft  shoulder,  and  not  reflected  directly  from  the  paper 
on  the  desk  into  the  eyes;  that  the  desks  are  designed  to  fit  not 
only  the  child  of  normal  size  for  his  grade,  but  also  those  who 
are  abnormally  large  or  small.  C.  L.  Scudder,  in  his  investi- 
I5« 


PHYSICAL  EDUCATION   IN  SCHOOIS  ,55 

gation  of  8chool-«ating,  in  Boston,  found  girl,  Hifferine  seven 

cZ  to  L      '"^'^- d»k'  of  such  l,eigh,  that  the  book  Is  forced 

?eTslo;^tr.h'"'°'''rr"''*"'-  Vm.  .here  are  found 
oesks  «>  low  that  ,he  round  shoulders,  the  drooping  heads  and 
the  flat  chests  of  their  occupants  are  sadly  noticeable. 


F«.  ..,._The  G.rl,r  d«k,  ^Ju.t.ble  b,  .hc  pupil. 


The  relation  Of  the  seat  height  to  the  desk  height  should  be 
such  as  to  permit  the  elbows  to  rest  on  the  desk  without  sZpin. 
Z^U^Z  r^:'>,-t\"''=  ^•'-'"-.  -d  'he  desk  edge  22 
r     P  '  "''^'  "^  ""^  '^'-     I"  '^  ^"^f^l'y  appointed  schc«r 

room  at  leas,  one  row  of  seats  and  desks  should  be  InTde  adjulul 
n  order  to  fit  pupils  that  are  not  of  the  regular  grade  size  Bv 
h,s,s  avoided  .he  unsuccessful  and  burdensle  meS    f  havil' 

w  iht  :t    """":'""  7^7''^-'-'"^'  -h.-ch  adds  an  additiold 
weight  to  the  teacher's  already  o,erloaded  shoulders  and  is  gen- 


J 

;!? 

1 

Mi 

( 

1 

III, 

1 

1 

k 

M 

■ 

i6e 


EXEBCISE  IN  EDUCATION  AND  HEDICINE 


erally  neglected.  Most  of  the  difficulty  in  seating  pupils  can  be 
overcome  by  a  self-adjusting  desk  and  foot-rest  like  that  invented 
by  J.  P.  Garber,  of  Philadelphia,  which  can  be  changed  to  fit  by 
the  pupil  himself  with  little  noise  or  loss  of  time,  the  two  great 
objections  to  adjustable  furniture  (Figs.  117,  118). 

A  perfect  fitting  seat  and  desk  can  guarantee  only  that  the 
child  shall  be  in  the  correct  sitting  position  occasionally  throughout 
the  school  day,  for,  however  well  the  desks  may  fit,  pupils  rapidly 
slump  unless  study  periods  arc  repeatedly  interrupted  by  oppor- 
tunities for  movement  and  exercise.    The  upper  part  of  the  body 


Fig.  118. — Showing  mechanism  for  adjustment  of  the  Garher  dealt;  to,  Adjust- 
able top;  14,  pivot  of  atuchment  for  adjustable  portion  of  top;  19,  lever  piesscd  up  by 
fingers  to  overcome  the  spring  31  and  release  the  rod  30  from  the  serrations  9.  allowing 
the  desk  to  be  raised  or  lowerrd  at  will. 


leans  forward  upon  or  against  the  desk,  constricting  the  chest, 
crowding  the  abdominal  organs,  and  impeding  the  venous  circula- 
tion. T  :  weight  is  supported  by  the  arms,  and  the  head,  neck, 
and  spine  hang  by  the  muscles  of  the  shoulder-blades  in  abnormal 
curves.  To  relieve  this  overstrain  of  the  back  and  shoulder  mus- 
cles the  pupil  changes  to  a  pose  resting  the  entire  weight  of  the 
trunk  on  the  shoulder-blades  and  lower  end  of  the  spine  (Fig.  1 1 9) . 
The  back  sags  down  in  a  single  long  curve,  the  chest  contracts, 
the  breathing  is  impeded,  and  the  circulation  made  sluggish. 
This  position  stretches  the  muscles  and  ligaments  of  the  spine, 
rounds  the  back  and  shoulders,  and  shoves  forward  the  chin. 


PHYSICAl   EDUCATION  IN   KHOOU  ,6, 

The  correct  sitting  ,x»ture  i,,  one  in  which  the  pupil  ,i„  erect 
and  the  head  po.sed  «>  a,  to  bring  the  center  of  gravity  within  a  line 

r^fciom  r  "'"'"'"•''  '"  ""'^'  =""'•"«''■  ''"•  "«=  demand 

Ind  lonJ'n.  1,     7"'^  '°  "''*  requirements  ill-fi.ting  deslcs 

^k^^lT  ',""""  '■"  "'"■='' '""'  P°^'"^  '«~"-  habitual 

the  mischievous  result  cannot  long  be  in  doubt. 


-Faully  posture  (Shaw). 


thJ^"  ^fr^V'  "''  ''"■''''^  ^"""'-"f^  ^'^""W  "ot  have  more 
than  one-dnrd  of  the  time  in  confinement  at  the  desk  (Shi 
Short  penods  of  s.tting,  followed  by  double  that  time  spentin 
muscular  acfvty  out  of  the  seat,  should  be  the  rule.    This  ^tivi  J 

exercse.  I„  the  kmdergarten  the  exercise  is  admirably  combined 
«th  mental  culture  by  the  teaching  of  imitative  games  in  which  the 
large  muscle  groups  are  exercised  in  hopping,  jumping,  and  run 


ill 


}!• 


i6t 


IXEKCtSE  IN   F.nUCATION  AND  HKDICINE 


ninR,  and  in  imitating  with  the  arms  thr  flight  of  birds  and  insects. 
The  circulation  is  stimulated,  and  postural  faults  are  prevented, 
while  at  the  same  time  the  child  is  taught  valuable  lessons  in 
natural  history,  in  which  his  interest  never  flags.  The  names  of 
these  games  are  suggestive  of  the  action:  "The  nindmill's  fans 
around   they   go"    (Blow),     "Mow,   mow   the   oats"    (Hofcr). 


—A  kimlergarteii  game  in  thr  sfho«>l  yar<l. 

"Little  ball  pass  along"   (Jenlis  and  Wallier).     They  may  be 
divided  into: 

1.  Games  of  pursuit — "Chasing  the  squirrel." 

2.  Imitation  games— "Shall  we  show  you  how  the  farmer?" 
(Blow). 

3.  Rhythmic  and  dancing  games — "Tick  lock'    (Hubbard). 

4.  Marching  games — "Left,  left,  listen  to  the  music "(Gaynor). 

5.  Ball  games — "In  my  hand  a  ball   I   hold"    (Jenks  and 
Walker). 


FHVSICAl  EDlICAnON  IN   SCHOOLS  ,63 

be  rjcll'Tfh  '"""'P'"'"' "y  ""-•  "1 "««'  of  them  c.„ 
uc  carrinl  on  to  the  primary  schools. 

In  the  succecdinK  years  of  the  elementary  school  the  pro,„rti„n 
i  I  71'-.  ";  '""•  ""^  "^  '^»'^-"y  '-K.hene<l,7m~ 
.Tuk  nh  ?  ■  "  """""  '^°"'''  "^  ''"I"™'  ""'I  •'"■"ted  to 
l.r.sk  physical  exercise.     In  the  last  year  of  the  elementarj'  schoo" 

1"Z   ;*',,'"''!"'"«   ""^  ""-  •'-'"S  'he  afternoon  sc-ssion. 
.levoted  to  exercise-,  corrective  in  character,  and  de»iKne.l  to  lirinK 

■i 


F«.   .„.  -A  re,™  ,.„e  a.  ,h.  Tho„,^„  s„„,  S.h„<4.  PMI„,e|phi,. 

into  use  muscles  inactive  or  overstrained  at  the  desk.     In  addition 

^s.sion  of  not  less  than  lifteen  minutes,  so  that  the  school-room 
may  be  thoroughly  aired.     All  the  pupils,   if  the  weathctTnd 

^L  ■       '  '?  ™"'  ''""'''  '""^  ^''^-^  ^•-'  ">  ">  ■>  I^n.-up 

animal  spirits,  quicken  their  circulation,  and  relie,e  the  nervous 
tension  caused  by  keeping  still,  and  .so  res.  and  invigorate  al    hd 

ulaX     'f  """"'''  ''''""■     '"  "->•  ^--'.  however,  par 
ularly  in  America,  children  see.  ,„  have  lost  the  know  Jj/e  of 


4, 


164 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


games  and  play  and  have  to  be  taught  them.  This  is  attributed 
by  Guh'ck  to  the  lack  of  play  traditions  found  in  the  mixed  and 
constantly  shifting  population  of  American  cities,  where  two  gener- 
ations of  children  seldom  grow  up  in  the  same  place  to  pass  down 
their  customs  and  play  rules  to  their  successors. 

Special  games  have  been  designed  and  collected  by  E.  H.  Arnold, 
of  the  Boston  Normal  School,  and  others,  adapted  from  old  and 
popular  children's  plays  for  the  use  of  the  many  children  who 
have  to  occupy  the  confined  space  of  the  playground.    These 


Fig.  133. — Mosher's  poatui^s  in  standing. 

games  should  be  taught  and  practised  during  the  recess  period, 
although  it  is  not  so  much  the  number  of  games  that  is  neces- 
sary, but  the  time  and  space  to  play  a  few  good  ones. 

The  school-day  of  children  in  the  higher  grades  should  have 
two  five-minute  periods  of  exercise  in  addition  to  the  purely 
corrective  work  of  the  three-minute  periods,  and  the  games  of  the 
recess  aboVe  described.  These  exercises  should  be  designed  to 
promote  quick,  strong  muscular  control;  to  expand  and  enlarge 
the  chest  for  deep  breathing;  to  bring  the  blood  out  into  the 
extremities;  and  to  teach  the  proper  carriage  of  the  body.    In 


PHYSICAL   EDUCATION  IN   SCHOOLS  jfij 

SrlT'^';'""''''^  P"^'""'  '"^  '-■=•■-  should  be  on  .he 
watch  for  the  most  frequent  of  all  defects,  that  position  where  the 
weigh  ,s  hab,tually  borne  on  the  right  leg,  the^t  being  Set  te 
and  placed  out  to  the  side  (Fig.  122,  ,)  ^  ^ 

It  is  not  possible  for  a  child  to  remain  long  at  rest  with  the 
we.gh  equal  y  on  both  feet  (Fig.  x«,  .).  and  siL  t     tension  on 
both  legs  IS  the  same,  the  child  rapidly  tires     Th^  h.^;  .Z^ 
.0  teach  is  that  recommended  by  Dr^^h'^g  -t  ,^    inT  l^^ 
one  foot  ,s  placed  slightly  in  advance  of  the  oLr.    h  n^ng 
feet  as  the  weight-bearing  leg  tires.  ^ 

r.!*"  ''^°fT'"  '"'^  been  the  battle-ground  on  which  the 

Sroronhe  "  '^"  '°"«'"  ""=  "'°''  ^•'■^°">-  -Sa  gn 
daj^^^  work  "'"'^"-  r--  Both  have  a  place  in  .he 
aay  s  work.      The  more  purely  corrective  exercises,  done  to  word 

ess  itn. hf /!:!'.  ''^'""^  •^'■"'°"^'  "^^  f"""''-'  "ore  or 
less  upon  the  Swedish  system,  while  rhythmic  exercises  done  .0 
music  and  the  teaching  of  movements  by  imim  ion  are  "o  e 
characerisfc  of  the  Germans.     Excellent  systems  of  g^^e^  To^ 

face!'ete"^"  '""'""""'•  '°  '"'"'  "'^  ''"'='«'°"=    "«>"  ""d  left 

arch'i:™  "  "'"""  '"^  ^"-'^  '-'"^"''  -din*^  or 
3-  Breathing  exercises 

and'wStr  '"""''  ""  ^°'"""''"™'  '"^  "^-'^"''■•"« 
5-  Back    including  shoulder-blade,  movements  for  the  spine 

and  general  carriage  of  the  body  '^    ' 

6   Abdominal  movements  for  the  abdominal  muscles. 

trunk  ^ds^r'  "''"'  """"■"'■"^  '°^  '"'  '^'-'  "--'-  of 


111 


;*  ' 


i66 


EXERCISE   IN   EDUCATION    AND   MEDICINE 


8.  Breathing  movements. 

g.  Jumping  movements,  like  the  fall-outs,  and  springing  move- 
ments, the  most  violent  of  the  series,  and  repeated  to  the  point  of 
breathlessness. 


-Method  of  using  the  school  furniture  to  replace  gymnastic  apparatus  in  Phil- 
adelphia schools.     The  "dip"  between  the  seald. 

lo.  Slow,  deep  respiratory  movements,  to  calm  the  respiration 
and  circulation  and  prepare  for  rest. 

Practically  no  apparatus  is  used,  except  the  school  seats  and 
desks,  and  the  alternate  rows  of  pupils,  who  act  as  living  supports 
in  duplicate  movements  (Figs.  123  and  124). 


Fig.  ia4. — *'  Follow  your  leader"  through  the  seats  and  aisles  of  the  school-room. 
The  alternate  files  in  the  picture  should  be  reversed,  and  the  game  continues  till  the 
players  are  back  to  their  own  desk. 

In  the  Philadelphia  i<:hools  recreation  drills  are  used  in  addition 
to  the  more  corrective  work,  and  sometimes  the  children  are 
allowed  to  run  freely  in  the  school  yard  for  one  minute,  or  to  take 
jumping  and  %'aultilig  exercises,   with  the  desks  as  apparatus. 


PHYSICAl  EDUCATION  IN  SCHOOLS  ,67 

o^irSln.'  ''"'  ^™^''^  '■"  "'"-'"'  -'  --  -P  ^^o" 
to  at7w'"' ''""'l^' P™"'"' "•'■''' '^  ^^™-'"'" '-g-^  enough 
ragether.  Here  the  dressmg-rooms  and  lockers  for  each  sex  ner 
m,t  a  complete  change  of  clothing,  with  the  liberal  uL  of  1 
shower-bath  and  swimming  pool.  The  school  gymnas.um  shol 
be  m  a  separate  building,  if  possible,  but  when  Zs  is  notTasibi 

w37:::t^,:rn:"--^'-ba^: 
^acu  Should  L::^\tii/-vrg'";r  s 

shotld  t  :"'  ^""^7  ^'^"'"*'  P"''"'^'  -"  horizontal  bar 
ona  1  H  """T  "!  ''"'"  '""'  '°  ^'^'  '°  f'"-'"'«'e  the  handling 
of  large  classes  and  these  should  be  set  in  the  door  sockets  casHv 

removable,  so  that  the  floor  maybe  cleared  for  mass  drlsr^rS' 
exerases,  and  games.  Around  the  walls,  chest  weigh  ^dS 
developing  appliances  should  be  set,  with  the  bom  and  !ull  ul 
and  the  dumb-belk,  clubs,  bar-beUs,  and  wands.  The"e  sho!ld  ^ 
an  ab     d  ,  ^^^     ^  ^^^^^  ^^  hounouM  b^ 

made  for  the  use  of  the  room  by  boys'  and  girls'  classes     Th! 
equ-pment  must  var,  widely  wi.h'.he'conditions,  andT  reliab 
firm  of  gymnasium  outfitters  should  always  be  c;nsulted    or  ,h 
design  and  mstalment  of  the  apparatus 

in  Z  n^  "  "  f  T^'"™'  ^ere  need  be  little  or  no  equipment 
each  pupU  (Burnham),  or  a  plot  300  feet  by  100  feet  for  a  school 
o  tooo  pup,ls;  but  if  not,  the  ap,«ratus  should  be  like  thaTora 
playground  cf  the  firs,  or  second  class,  already  describS 
buildinTw""  ""'""  "'  ""^  "'  playgrounds  about  the  school- 
New  Yokt°""rT"'  '"°"  "'«^"''  """^  '■"  Philadelphia  and 
New  York  the  roof  „self  is  used,  caged  in  by  wire  netting      Th^ 


i68 


EXERCISE   IN    EDUCATION   AND   MEDICINE 


roof  playgrounds  give  the  only  opportunity  a  child  may  have  fw 
engaging  in  outdoor  athletics,  and  in  New  Yorli  city,  where  the 
population  is  so  dense,  it  has  made  possible  the  formation  of  the 
public  School  Athletic  League,  which  is  now  over  half  a  million 
strong. 

The  Public  School  Athletic  League  of  the  city  of  New  York 
was  founded  in  1903  by  Dr.  Luther  Halsey  Gulick,  then  Superin- 
tendent of  Physical  Education.  He  brought  to  the  attention  of 
the  Board  of  Education  the  deplorable  physical  condition  of  the 
children  attending  the  public  schools,  most  of  them  living  in 
many-storied  tenements,  each  with  a  [wpulation  as  great  as  a 


'f^&li' 


>»■i^ 


Fig.  135.- 


-A  roof  playground  in  a  crowded  section  of  New  Vorit  (PlayRrounds  Association 
of  New  York). 

small  village,  with  no  playgrounds  but  the  crowded  streets  and 
congested  sidewalks.  It  was  estimated  that  in  the  tenement 
district  of  the  east  side,  Manhattan,  there  was  a  child  for  each 
running  twenty-four  inches  of  the  street,  which  was  emphasized 
as  just  the  space  required  for  a  grave.  The  committee  of  the 
board  approved  the  scheme,  and  incorporated  the  league.  The 
organization  was  perfected  by  the  election,  as  officers,  of  men  in- 
fluential in  the  political  and  financial  world,  and  by  securing  the 
cooperation  of  teachers  and  principals. 

The  lirst  athletic  meeting  was  held  at  Maiison  Square  Gsrden 
before  much  opportunity  had  Ijeen  given  for  work  among  the  boys. 


1% 


PHYSICAL  EDUCATION  IN  SCHOOLS  ,6p 

over  IS,:;'  •'°°™'"'"-     ""^^  "^-  '"^  '-«-  has  given 


Boys  were  classified  by  weight  instead  of  age   the  scales  bein       . 
MityoLiscussln     Vre^^r,^^^^^^^^^^^^^^ 

-i.ing,  putting  the  ^^r^:^.^xzti^:^T '"''- 

and  .n  X907  there  were  ,c6  baseball  teams  competing  agai^t'each 


'7° 


EXESCISE  IN  EDUCATION  AND  HEDICINE 


Other  in  the  league.  Valuable  trophies  and  medals  have  been 
secured  for  competition,  and  many  other  devices  are  used  for 
extending  the  exerc'se  to  as  many  hoys  as  possible. 

Prize  buttons  were  given  to  all  boys  who  achieved  a  certain 
standard  of  merit.  To  win  the  button  he  must  chin  the  bar,  run  a 
certain  distance,  and  jump  a  certain  height,  according  to  his  age  or 
weight.  The  standards  have  been  set  as  follows:  For  elementary 
school  boys  under  thirteen  years,  6o-yard  dash,  8f  seconds;  chinning 
the  bar,  4  times;  standing  broad  jump,  5  feet  9  inches.  For  all 
other  elementary  school  boys:  60-yard  dash  indoors,  8  seconds; 
100-yard  dash  outdoors,  14  seconds;  chinning  the  bar,  6  times; 
standing  broad  jump,  6  feet, 6  inches.  For  high  school  boys: 
230-yard  run,  28  seconds;  chinning  the  bar,  g  times;  running  high 
jump,  4  feet  4  inches.  This  has  been  extended  to  class  competition, 
where  all  boys  in  the  class  compete  to  make  an  average. 

The  league  aids  in  the  maintenance  of  discipline  by  requiring  a 
certificate  from  the  principal  stating  that  the  boy  had  reached  the 
passing  mark  in  his  studies  and  deportment,  before  allowing  him 
to  compete  either  for  a  button  or  other  prize. 

In  the  first  contest  for  the  button  only  three  or  four  out  of  a 
school  of  500  could  pass  the  test,  bi)(  with  practice  1162  boys 
qualified  in  1904,  and  two  years  later  this  number  had  more  than 
doubled. 

Teachers  have  been  astonished,  as  well  as  pleased,  with  the 
improvement  in  discipline  among  these  young  and  ambitious 
athletes,  and  this  alone  has  insured  their  active  cooperation,  as 
well  as  the  enthusiastic  support  of  the  boys. 

Systematic  instruction  in  military  rifle  shooting  has  been  made 
possible  by  the  invention  of  the  subtarget  machine.  It  consists  of 
a  standard,  with  an  ordinary  Krag  military  rifle  attached  to  a 
mechanism  on  top.  This  is  so  adjusted  that  when  aim  is  taken 
with  the  rifle  at  a  target  across  the  room  and  the  trigger  pulled, 
the  machine  registers  upon  a  miniature  target  the  exact  relative 
place  that  would  have  been  hit  if  the  gun  were  loaded.  As  there  is 
no  danger  connected  with  it,  the  practice  is  rapid  and  economical, 
the  mechanism  being  easily  set  up  in  any  school-room.     The 


PHYSICAL  EDUCATION  IN   SCHOOLS  171 

instructor  standing  at  the  lx>y's  side  is  able  to  follow  the  man- 
ner in  which  he  is  aiming  and  to  correct  his  defects.  In- 
struction in  the  holding  and  sighting  of  the  rifle  is  given,  and 
annual  interschool  contests  are  held,  ending  in  a  final  contest 
among  the  winning  schools  at  Creedmoor,  with  the  actual  rifle, 
at  distances  of  from  loo  to  400  yards.    The  boys  thus  have  an 


Fig.  i.7.-Subtt,w.,   Kun    machine   I„r    rifle  practice  in  high  school,  (Handbook  of 
Public  School  Athletic  League,  N.  V.). 

opportunity  for  acquiring  the  knowledge  of  wind,  atmosphere, 
and  light,  necessary  for  good  shooting  in  the  field.  This  has  been 
made  part  of  the  program  for  the  School  Athletic  League,  and  has 
been  a  source  of  keen  interest  to  the  Ijoys,  many  of  whom  have 
acquired  great  skill.  Upon  attaining  a  certain  degree  of  efficiency 
each  competitor  is  given  a  badge.  The  national  importance  of 
having  an  army  of  boys  graduated  every  year,  each  one  knowing 


172 


EXERCISE  IN  EDUCATION  AND  UEDICINE 


the  feel  of  a  rifle  in  his  hand,  and  having  a  knowledge  of  its  use, — 
a  knowledge  that  never  leaves  him,— need  not  be  dwelt  upon  here. 
The  Athletic  League  has  extended  its  work  by  the  formation 
of  the  girl's  branch.  Voluntary  classes  in  gymnastics,  games, 
and  dancing  have  been  introduced  among  the  girls  attending  the 
public  schools,  from  which  teachers  are  by  no  means  excluded, 
many  of  them  attending  and  in  turn  leading  classes  of  their  own. 
Exercises  most  popular  and  generally  practised  by  the  girls  are  the 
peasant  dances  of  Sweden,  Scotland,  Ireland,  and  Spain,  involving 
much  gymnastic  work  and  developing  strength,  agility,  and  grace. 


Fig.  138.— Relay  race,  Girls'  Branch  ejblic  Schools  Athletic  League. 

Games  adapted  for  indoor  and  outdoor  spaces  are  practised,  and 
relay  races  between  classes  and  schools  have  become  a  favorite 
feature. 

Owing  I-'  the  difficulty  in  finding  a  spacious  ground  for  their 
athletic  competitions,  the  Public  School  .\thletic  League  has  been 
the  means  of  drawing  attention  to  the  need  of  good  playgrounds 
in  New  York  city.  Largely  through  the  influence  of  its  officers, 
$400,000  were  appropriated  by  the  city  for  the  purchasing  and 
equipping  of  four  athletic  fields.  Because  of  the  enormous  cost  of 
land,  it  was  impossible  to  procure  sites  on  Manhattan  Island,  so  that 
one  was  built  in  Astoria,  one  at  Crotona  Park,  another  at  Stapleton, 


PHYSICAL   EDUCATION   IN  SCHOOLS 


'73 


Stolen  Island,  and  the  fourth  in  south  Brooklyn.  These  fields 
are  equipped  with  running-tracks,  xrand-stands,  and  dresslni?- 
rooms;  but  if  adequate  provision  had  been  made  as  the  city  was 
built,  it  would  not  have  been  necessary  to  jjo  so  far  afield. 

Leagues  similar  in  oliject  and  character  have  since  then  lieen 
formed  in  Newark,  Chicago,  and  Cleveland.  In  Newark,  where 
the  work  is  particularly  active,  a  medical  examination  of  all 
contestants  is  required,  aljout  80  boys  being  found  physically 
unfit  out  of  aooo  competitors. 


Fig.  ..9.-Field  day  tor  school  rhildrfn,  Franklin  Firld.  Philaddphi.,,  June  ,o.  „o8 
(PlayKTOunds  Association  of  Philadelphia). 

The  Playgrounds  Association  of  Philadelphia  has  an  athletic 
committee  to  organize  the  athletic  interests  of  the  schools,  both 
public  and  parochial,  and  the  first  field  day  was  held  in  June, 
1908,  with  5000  children  of  both  sexes  taking  part.  It  differs  from 
the  leagues  of  New  York,  Newark,  and  Cleveland  by  laying  more 
stress  on  interschool  competition  in  drills  and  games,  where  as 
many  as  400  pupils  from  one  school  took  part  in  a  drill  in  com- 
petition with  groups  of  50  to  100  from  smaller  institutions.  In 
addition  to  this  there  were  group  contests,  relay  races,  and  indi- 
vidual events. 


CHAPTER   XI 

PHYSICAL    EDUCATION    IN    THE    COLLEGE    AND 
UNIVERSITY 

The  university  is  the  culmination  of  the  educational  system, 
but  there  is  a  distinct  break  between  it  and  the  school.  Most 
school  children  go  into  the  business  or  trade  they  are  to  practice 
for  the  rest  of  their  lives  when  they  leave  school,  and  many  men 
enter  college  who  have  had  but  a  meagre  experience  of  school  life, 
and  the  struggle  for  a  college  education  is  so  intense  that  the 
exhausting  work  of  preparation  is  frequently  stamped  on  the 
physique  of  the  matriculant. 

The  long  hours  of  school-work,  the  nervous  exhaustion  of 
teaching,  the  nights  spent  in  study,  and  the  days  in  office,  factory, 
or  shop — all  leave  their  imprint  so  deeply  that  the  knowledge  of, 
and  even  the  desire  for,  a  larger  and  fuller  physical  life  may  be 
stamped  out  or  atrophied  in  the  very  youths  whose  success  in 
after-life  depends  on  the  conservation  and  development  of  their 
physical  powers. 

Physical  education  for  college  students  must  then  include  per- 
sonal hygiene  and  the  correction  of  remediable  defects,  the  educa- 
tion of  their  physical  powers  to  the  highest  point  of  efficiency,  and 
the  cultivation  of  those  social  qualities  that  can  be  taught  through 
the  agency  of  athletic  activity  better  than  by  any  other  means. 

The  necessity  for  physical  training  to  go  hand  in  hand  with  the 
other  courses  of  the  college  curriculum  has  always  been  recognized 
by  advanced  thinkers  in  the  realm  of  college  education. 

Benjamin  Franklin,  in  wTiting  his  pamphlet,  in  1749,  that  led 
to  the  founding  of  an  academy  for  the  education  of  the  youth, 
now  the  University  of  Pennsylvania,  expressly  states  that  "To 
keep  them  in  health  and  to  strengthen  and  render  active  their 
bodies,  they  be  frequently  exercised  in  running,  leaping,  wrestling, 
and  swimming" ;  and  nearly  forty  years  later  Thomas  Jefferson  wrote 


FHVWCAl  EDUCATION  W   THE  COLIEOE  AND   IN.VCMITV      .75 

™       '"*  ■*" '"  ""e  conditions  then  existing, 
a  Jt  %!?'  "'  ;"'T.'"  °""^  «y™"'"«^''  ««^hed  America 
'uh^    n  ,h       ?  K?!'  ''"'"■'^  '■"  "  P"^'""'  chapter,  and  Z 
^u  ted    „  the  esubl«hment  of  gymnastics  as  part  of  the  regular 

rS°,^ColJ:e^H°""'  r  -■^•-""-^-"■amp.on.MLTand 
o  nr^hlf    p"!;  "■' "'"°8"^»  "f  •8.7-,8  containing  the  name 

insLo  "' Ge^a?  TC"--^-  »'  '-«  0~i-."  a^d 
Bro^J^.--— ;::;-;^e.in. 

^::=:z^t:rsi^:;r:;r;;:.^= 

subjects,  ^d         „.,^  of  teaching  boys  to  turn  Lersau     Then 
In  i860  the  first  chair  of  Phy,ical  Education  and  Hygiene  in 

s^ni  "u?„T'.r"  T  ""u"'"'  '^  °^-  ^"•"'l  Hi,chcock,Tho 
stisfc  a  re  th  ^  "''"'  ""'  """^  ">easurements  and  vital 
i^e  men.    H,s  conclusions,  as  embodied  in  charts  and  reports 

J^hn^nTT"'  ™'"°"'"™'  '"  '"^  ^'"''-•'^  health  fXh^ 
freshman  to  the  senior  year  under  his  system  of  exercise  as  well 
as  an  increase  in  muscular  development 

new' HeL'en''''  ^'""'^  •'•  '"«™'  ""^  «'^™  -  -"section  of  the 
new  Hemenway  Gymnasium  at  Harvard,  and  he  at  once  began 
he  patient  accumulation  of  vital  statistics,  now  reduce^'o  cC 
form  and  available  for  comparison. 

less^ol!?''?  "'"'^''  ""''  ""■■^•^"'■"•^^  have  established  more  or 
ll  ,„r  <^r"™™'^  "f  Phy-cal  education,  in  which  a  definite 
amount  of  exercise  is  required  of  from  one  to  four  classes. 

in  ct.  ",  ^^^"'""^  '""""  ■""*  ""■letics  was  founded 
m  Chicago  in  ,89,,  and  in  ,904  .he  BarUet,  Gymnasium  It 


176 


EXERCME  IN   EDUCATION   AND  MEDICINE 


opened.  This  was  a  radical  de|)arture  for  a  large  university 
because  there  was  a  definite  undergraduate  requirement,  and 
provision  was  made  for  ade<)uatc  supenision  and  control,  financial 
and  otherwise,  of  university  athletics.  This  made  [lossible  the 
ideal  relationship  between  physical  training  proper  and  com- 
petitive athletics,  each  having  its  place  in  the  complete  sy.tem  of 
physical  education. 

The  Department  of  Physical  Education  as  reorganized  in  igo4 
at  the  University  of  Pennsylvania  requires  from  the  four  under- 
graduate years,  and  from  the  primar)'  years  in  the  professional 
schools,  except  those  holding  a  bachelor's  degree,  a  minimum  of 
two  periods  of  exercise  a  week,  and  lectures  on  the  application  of 
exercise  to  disease  are  given  lin  the  medical  course. 

A  wide  option  is  allowed,  and  equivalent  credit  is  given  for 
attendance  at  the  gymnastic  classes  or  durmg  active  membership 
on  the  foot-ball  squad,  crew,  baseball,  track,  or  swimming  teams, 
and  in  the  fencing,  wrestling,  or  boxing  clubs. 

In  the  College  of  the  City  of  New  York  the  requirement  is 
much  more  exacting,  and  in  nineteen  of  the  leading  universities 
this  department  is  now  on  an  equal  basis  with  the  others,  the 
theory  of  hygiene  and  physical  training  forming  one  of  the  college 
courses  in  many  of  them. 

A  university  course  in  physical  education  should  begin  with  acare- 
ful  examination,  to  find  the  exact  physical  condition  of  the  student 
and  so  to  give  an  intelligent  foundation  on  which  to  base  advice 
and  instruction.  He  should  be  measured  and  his  strength  tested, 
to  see  how  he  compares  with  his  fellows  in  proportions  and  power. 
His  posture  and  development  should  be  noted,  and  his  heart  and 
lungs  examined  for  any  latent  weakness  or  disease.  The  acuteness 
of  his  sight  and  hearing  should  be  carefully  calculated,  for  he  must 
know  if  there  be  any  serious  obstruction  of  the  two  most  im- 
portant avenues  by  which  his  knowledge  is  to  come  to  him.  .\nd, 
finally,  his  ability  to  accomplish  certain  muscular  feats  that  cover 
the  main  activities  of  the  body  should  be  ascertained. 

An  analysis  of  the  examination  cards  of  looo  freshmen  showed 
that  over  30  per  cent,  had   lived  a  sedentary  and  confined  life. 


FHV.ICAI.  EDUCATION  IN   THE  COLIEOE  AND  INIVMSITV      ,77 

While  more  than  60  ,«r  cent,  showed  some  mrkecl  ,.hy,ical 
defect;   the  broken-down  .rch   of   the   foot;  the  fl«,  chL,  and 


UNIVEB8ITV  OP  PENNSYLVANIA 


r-w_  ....*i« 


••*••...  I^^^^^""**"—  --.j^" 


...i..'*y*,.f.*ira-..v!' " ' 


ta  «»  te«i  ....,..,**  * 


«wM»>Mi....-..y.. 

■'.-■Ml .0... 


52_ 


■  •-" g«*-... 


....3««*<. ' 


•~— ■— ' ■■ynu'Tr. 


- —    r^ 


Fig.  ijo.-History  blank  filW  by  the  iludenl. 


protrudmg  abdomen  of  the  anemic  school-boy,  with  his  round 

houHe"'  T?'"^  ""■"•  '""'  "'"'''y -""-'-.  or  the  drooping 
shoulder  and  the  curved  spine,  or  the  dull  hearing  and  faulty 


178 


EXERCISE  IN  EDUCATION  AND  HEOICINE 


sight  that  had  been  the  unsuspected  cause  of  headaches,  nervous 
irritability,  and  exhaustion. 

It  is  tlie  province  of  the  department  of  physical  education  to 
bring  this  defective  physique  up  to  its  normal  level. 


m.J(a3 

UNIvatUTV  OP  PENNIYLVANU 

MMOTMBfT  «F  PMVMCAL  nUCATWI 

MMCMBUNMJnM 

~.  ...J.P..:./:..P.f.. 

OM  ..^W!f AM  '* 


toE 


ffrr. \ »-.».,y^Mr«W 

llHMaMatK  Hh*  .^f.%.W. >•«•.. ^PTPPFf^ 

■  .^M.lT. tMgta. . .itf.t. m. ntim.^ff^f^,, 

.....ifA:. 

^.^^.IJU. «,, r.!/r. 

—■%  *M«i 3.0. wmmm-.J.^.'^...... 


I-M>  111*111   ...  I^Ot.... 


.—«...  ...r....  1. ./:... 


..fr*T«y^.i-.w«..y^^!?*.r<'.f.f.^.«.TMV^..-^r:*' 
H!<.«TI*.Trf^^»«<..,...J*li»**;.»«U. _ 


Fig.  131. — Form  for  medical  examination. 

The  main  work  of  the  director  must,  however,  be  devoted  to 
the  average  man,  coming  from  the  farm,  the  office,  the  factory, 
the  shop,  or  the  school,  with  no  athletic  ambitions,  but  wanting 
to  make  every  moment  of  his  time  count.  The  college  must 
provide  him  with  enough  exercise  of  the  right  sort  to  put  and 
keep  him  at  the  highest  level  of  physical  efficiency  to  get  the 


PHYSICAL  EDDCAnON   IN  THE  COLLEGE  AND  UNIVEKSITY     179 

most  good  from  his  lectures  and  laboratory  work,  without  in- 
volvmg  too  great  an  inroad  upon  his  limited  time. 


Fig.  133.— Measurement  form. 


The  athletes  must  also  be  provided  for  in  the  scheme,  al- 
though they  number  less  than  lo  per  cent,  of  the  total  enrolment 


D«e ^^/t,.     Itt_f_ 

N«...f-..c._.i:„.i.. ci-i. 

Enmiutioa  of  E^:  K.  | 

Eaenul  Co.Jiiioa_<Sy,«^. #<•  jyM«.  I 


Ophthklomcope... .. 


-.*— ....y(^*^ „..,...,  ^ 


^'8-   133— Form  of  eye  examination,  U.  of  P. 

of  the  college,  for  the  severity  of  competition  in  intercollegiate 
athlefcs  and  the  high  standard  of  merit  required  for  success 
separates  them  aln  ost  into  a  special  class. 


i8o 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


The  average  weight  of  a  foot-ball  player  on  a  college  team  is 
about  174  pounds — 35  pounds  more  than  the  average  man.  The 
oarsman  weighs  about  164  pounds,  or  25  pounds  more  than  the 
ordinary  student,  whose  height  he  also  exceeds  by  about  three 
inches.  The  light,  routine  exercise  sufficient  for  the  average 
student  is  not  enough  for  them,  and  yet,  while  facilities  should  be 
given  them  for  practising  their  chosen  sport,  the  necessity  of 
advice  and  direction,  and  in  some  cases  restriction,  has  time  and 
again  been  tragically  shown. 


■H^-l    /I 

^mmm 

1 

1 

N 

'--&:' 

\ 

■h 

WSSIR 

^S- 

-..I* 

V 

V 

Fig.  134- 


-  Rxercise  to  develop  the  abdominal  muscles  on  the  Swedish  stall  Ian., 
V.  of  P.  gymnasium. 


All  three  classes  of  men,  the  defective,  the  normal,  and  the 
athletic,  should  be  inclufied  in  the  plan  of  a  complete  depart- 
ment of  physical  training. 

For  specific  defects,  prescribed  exercises  are  required. 

Recently,  a  young  man  came  to  college,  having  been  rejected 
at  West  Point  because  of  flat-foot  and  lateral  cur\ature.  A  six 
months  course  of  prescribed  exercise,  lasting  about  half  an  hour 
daily,  and  carried  out  faithfully,  enabled  him  to  pass  the  required 
physical  examination  easily.  Another  freshman  entering  on  the 
study  of  architecture  complained  that  he  could  not  study  on 
account  of  frequent  headaches,  especially  after  reading  and 
drafting.  His  eye  examination  showed  less  than  half  the  normal 
acuity,  unsuspected  and,  of  course,  uncorrected  by  glasses. 


PHYSICAL   EDICATION   IN    THE   COLLEGE   AND    INIVERSITV      l8l 

Hundreds  of  such  cases  come  under  the  medical  examiner's 
eye  each  year,  and  proper  advice  at  the  beginning  of  his  course 
w,ll  prevent  the  appalling  waste  of  time  ami  energy  inevitable  for 
the  man  who  struggles  along  with  these  handicaps  uncorrected 
Constant  personal  counsel  about  exercise  and  other  questions  of 
hygiene  go  far  to  add  to  the  comfort  and  efficiency  of  these 
students. 

A  course  of  exercise  of  progressing  difficulty  should  be  carefully 
designed  ami  graded  for  the  average  man,  who  is  neither  subnormal, 
like  the  defective,  nor  supernormal,  like  the  athlete;  who  has 
nether  the  desire  nor  the  ability  to  represent  his  university  ur»n 
the  track  or  field,  but  who  wishes  to  be  at  his  highest  point  of 
physical  vigor  throughout  his  college  course. 

A  fixed  requirement  is  essential,  with  credits  on  the  basis  of 
laboratory  work,  because  a  course  of  exercise  requires  guidance 
quite  as  much  as  the  other  subjects  of  the  college  curricu.uLi,  and 
the  student's  attitude  will  naturally  be  antagonistic  to  require,! 
vvork  of  any  kind  unless  credit  be  given  for  the  time  taken  from 
those  studies  which  he  thinks  have  a  more  direct  bearing  on  his 
lifework. 

Two  objects  must  be  kept  in  view  in  planning  such  a  course: 
first,  the  correction  of  those  bad  physical  habits  that  come  with 
the  student's  sedentary  life;  and,  second,  the  systematic  educa- 
tion of  those  bodily  powers  that  will  be  most  useful  to  him  during 
his  college  life  and  after  graduation. 

The  sudden  change  from  the  active  outdoor  life  of  the 
country-bred  boy  to  the  confinement  of  college  work  is  not  unat- 
tended  with  dangers  to  health,  as  shown  bv  the  tendency  to  con- 
stipation and  other  disturbances  of  digestion,  headaches,  and  the 
other  common  ills  for  which  the  college  medical  examiner  is 
continually  consulted.  The  long  hours  spent  in  the  lecture-rooms 
not  always  too  well  ventilated,  or  bent  over  the  laboratory  table 
must  also  be  corrected  by  exercises  that  will  strengthen  the  tired 
back  and  stimulate  the  sluggish  heart  and  inactive  digestion,  that 
«-.l  draw  the  blocxl  from  the  tired  brain  and  congested  abdom- 
inal organs  into  the  pulsating  muscles  .nd  expanded  lungs,  and 


■^h 


l83 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


I 


If 

is 

...ii 

\m 


the  means  used  must  at  the  same  time  be  such  as  to  give  a  real 
education  to  his  physical  powers. 

A  successful  course  must  develop  those  racially  old  coordina- 
tions that  have  given  man  his  supremacy  over  the  brute  creation, 
and  civilized  man  his  superiority  over  the  savage  for,  contrary  to 
popular  opinion,  the  civilized  nations  are  as  dominant  physically 
as  they  are  intellectually. 

It  is  by  the  cultivation  of  the  great  fundamental  and  vital 
activities  that  civilized  man  has  asserted  and  maintained  his 
superiority  over  more  primitive  races,  and  the  rehearsal  of  these 
activities  must  form  the  basis  of  a  course  in  physical  education  if 
it  is  to  be  interesting  to  the  student  and  sound  from  tb '  stand- 
point of  the  pedagogue.  These  are  the  exercises  of  locomolion, 
running,  jumping,  climbing,  and  swimming;  ofjigkling,  throwing, 
catching,  dodging;  striking,  and  wrestling,  and  of  cooperation 
under  a  leader  in  group  games  where  men  are  organized  in 
teams,  individual  excellence  being  sacrificed  to  the  common  good. 

The  cultivation  of  physical  intelligence  can  never  lose  its 
value,  no  matter  how  artihcial  may  be  the  conditions  of  the  com- 
munity in  which  he  lives.  It  is  what  teaches  a  man  to  escape 
injury  in  the  many  emergencies  of  daily  life;  it  saves  what  would 
be  a  broken  arm  or  a  sprained  wrist  in  one  who  had  not  learned 
how  to  keep  his  feet  on  the  slippery  pavement  or  how  to  fall  with- 
out hurting  himself,  and  many  costly  lives  are  lost  annually  through 
inability  to  swim,  jump,  climb,  or  dodge.  These  fundamental 
actions  of  locomotion  and  fighting  form  the  basis  of  all  games  that 
have  survived  to  the  present  time,  but  exercise  for  the  college 
student  must  be  put  in  such  form  as  to  get  the  greatest  jxjssible 
result  for  the  time  expended.  Games  must  be  mwlified  and  in- 
tensified to  fit  the  conditions  of  college  life.  It  takes  a  field  no 
feet  by  60  feet  to  accommo<late  22  men  in  foot-ball,  24  in  lacrosse, 
or  18  in  baseball,  but  1000  men  can  be  exerci.scd  in  the  same 
space  in  similar  movements  by  arranging  them  for  class  work, 
and  tile  course  can  be  progressive  and  logical  from  the  teaching 
standpoint  at  the  same  time. 

In  the  illustration  (Fig.  135)  a  class  of  nearly  500  students  is 


N     I 


I«4 


EXERCISE   IN    EDCCAIJON   AND   MEDICINE 


seen  engaged  in  athletic  exercise 
on  Franklin  Field.  Each  man  in 
turn  sprints  30  yards,  clears  a 
hurdle,  takes  a  standing  broad 
jump,  a  running  high  jump,  and 
puts  the  12-pound  shot,  a  short 
pause  taking  place  between  each 
act.  The  signal  is  given  by  a 
whistle,  and  at  each  signal  nearly 
100  men  perform  one  of  these  feats. 

Class  work  should  be  made 
progressive  in  difficulty,  each 
movement  leading  into  the  next 

In  teaching  a  movement  like 
rope  climbing,  the  student  should 
be  first  examined  and  marked  as 
to  his  ability  to  climb  a  rope  by 
his  arms.  If  he  cannot  do  so  at 
all  (about  40  per  cent.),  he  should 
begin  by  pulling  his  weight  up 
once  by  both  arms  and  dropping 
to  the  floor.  He  should  then 
learn  to  jump  and  catch  the  rope, 
pulling  his  weight  up  several  times, 
afterward  learning  to  catch  the 
rope  with  the  arms  and  legs  and 
climb  by  the  use  of  both,  and  so 
on  until  he  is  able  to  climb  with 
ease  l)y  using  the  arms  and  legs 
or  arms  alone;  to  carry  the  rope 
up  with  him;  to  tie  a  loop  in 
which  he  can  rest,  or  to  descend 
with  one  arm  disabled  or  carrying 
a  bundle.  He  is  then  reexamined 
and  passed  in  that  method  of 
locomotion. 


various  s.rokrTn" luZl"!""""  '"'"'"■  ""  ''*""-  ">  "'' 

'eft  and  right    a«l  '  "r       r    .         '?""'"  "'  '''=f'="'*-  ""^  '^ads, 
increasing' on.Srwih,"'"':'''  """"  '"  ™"">'"a.ions,  of 

*"'"'*"  of 'his  metho<   of  flefins^       ru         ,■ 
of  wrestling  should  also  be  taught  in  ,h  .  "  ''"''""'^■"s 


■IK   u.-fd   is  a  <ias3  fAerrise  (I  . 
hold. 

every  man  to  know  his  nowpr«  anri  i;«,-.  ^- 

of  running    leauin.-   .n^  r    ,        '"""a"o"s  m  all  the  activities 

complete  fa  fa  led  "'/'"'•  ."'"'^  ""  '"'''^  "-'^  '- 
cal.'„.ental  and  ehilal  ofThT  "':,'^''."^^"-''-'  -^lue,  physi- 
courage,plucMn;:r;t;;C;r"'^  ^'-""^  '^^'-'''- 

lighted  g;n„;asi'  '  "  ■^'''^'°"-''  -"-"<''-«-'.  and  well- 

'  The  gymnasium  shnul.l  1 ,.  i.rnvideH  wi.h  „        , 

l-ible,  much  may  ,.  don  tZ  u^  ,7?!  '  ''''  ''"'  """^  '"-  i.  „,„ 
^all  may  ,.  divi,,..,  i„,„  cur,,,' and  ,»!  L  '  'r  '^''-  '''•  -"'''  "  '-8^ 
be  practised  wi.hou,  interference  „r  dant.a  d  I''  T"  ^'""^'""  "->• 
-  ^y  one  man.      Separate  _.  ace  ^  ^.t;?:-::  -  ^  ;"- 


i86 


EXEKCI8E  IN   EDUCATION  AND  MEDICINE 


A  year's  course  of  extrtise  will,  of  necessity,  vary  considerably 
with  the  special  conditions  to  be  found  in  the  college  or  university, 
but  the  following  plan,  which  is  in  use  at  the  University  of  Penn- 
sylvania, will  be  found  to  contain  the  main  essentials  of  progression. 

October:  Physical  examinations  and  examination  of  eyes,  in- 
struction in  swimming  to  first  year  men;  prescription  and  demon- 


Fig.  T3fi. — Gymnasium  floor  divided  into  three  rourts  by  nets,  thus  permittinit 
bultet-ball  in  the  central  court  and  wrestUnR  and  gymnastics  at  the  two  jr.ds.  This 
aUows  of  supervision  of  the  whole  flijor  by  one  man  (University  of  P.'niisylvania). 

stration  of  special  exercises  for  round  or  uneven  shoulders,  con- 
stipation, flat-foot,  weakness  of  abdominal  walls,  etc.,  given  by 
the  instructors  on  the  gymnasium  floor. 

Nmember  1-25:  Class  work  in  the  gymnasium.     Marching 

(or  the  indoor  preliminary-  practice  of  the  crew  (Fig.  t4o),  itockcy  team,  or  base- 
ball team.  Corrective  exercises  are  also  better  done  apart  from  the  noise  and 
confusion  of  the  main  exercise  hall  with  its  constant  succession  of  classes. 

In  the  practical  management  of  claases  the  advantage  of  having  the  ap- 
paratus in  sets  of  six  (Fig.  i^g)  is  great.  B^-  this  means  the  larj^est  class  may 
be  so  divided  as  to  prevent  the  waste  of  time  that  orrurs  when  a  long  line  of 
men  must  wait  their  turn  to  perform  their  enercise  oo  a  single  horse  or  pair  of 
ban. 


reVSlCAL  BDUCATION  IN   THE   COllECE  AND   I'NIVEHSITY     187 

tactics,  quick  time  and  double  time;  free  setting-up  exercises- 
gymnastic  games.  ' 

Nm>cmber  i^-Dectmber  i:  Examination  on  first  arrangement 
of  apparatus;  low  horizontals,  climbing  ropes,  flying  rings,  and 
yaultmg  horse.  Men  are  graded  as  a  result  of  this  examination 
mto  first,  second,  third  (or  leaders),  and  fourth  (gymnastic  team) 
grades. 


''W.  ■W-Gynumium  floor,  shomng  ,pp,«iu.  in  pUce  tor  cla»  work      Bnrin- 

p.n.lld  b.r,  .na^  i„  g.„g.  ^  ,(.,     The  p.r.11.1  bar,  are  placed  m  fl«,r^k"., 
and  can  b.  „pl.ced  by  the  buck  or  Ion,  side  ho™  (Univc„i>y  of  Pennsylvania,. 

December  i-January  27:  First  arrangement  of  apparatus, 
about  ten  consecutive  lessons  on  each  piece,  progressing  in  dif- 
ficulty.    Drill  with  wooden  dumb-bells.     Reexamination. 

February  i-March  4:  Second  arrangement  of  apparatus 
High  horizontal  bar,  tumbling,  buck,  long  horse,  and  parallel 
bars,  class  drill  with  wooden  wands  or  Indian  clubs,  preceded 
and  foUowed  by  examination  and  regrading.     Indoor  exhibition. 

March  4-April  i :  Third  arrangement  of  apparatus.    Pyramid 


11 


t88 


EXERCISE  IN  EOCCAHON  AND  MEDICINE 


building,  boxing,  or  wrestling;  drill  with  iron  dumb-bells  or  steel 
wands;  dancing  steps.  University  circus  given  by  the  leader's 
corps. 


FlK-    140. -Indoor  practk'i;  for  c „„..  ,.,....,» 

actual  rowing  on  thu  river. 


iiidiilAtot  iluring  the  vviiiu-r  in   pr(^i>arstion  lor 


1 

9                ] 

— , '    _._  U 1  -  -     1-  •- 

A^    y            -      ■ 

/     - 

/ 

Fig.  Mi.^The  building  of  pyramids  as  a  class  Mercisr,  U.  of  P.  gymnasmm. 

April  i-Afay  5:  .\thletic  sports  indoors  or  on  Franklin  Field 
when  possible.,  The  start  in  sprinting;  hurdling;  broad  and  high 
jumping;  putting  the  shot;  running  and  dancing  steps.  Outdoor 
exhibition  of  the  united  classes. 


PHYSICAl  EDI/CATION   IN  THE   COLLEOK   AND   IMVERSITY     .89 

May  i-June  i :  Physical  examination  of  the  graduating  class 
It  ■»  found  that,  after  two  or  three  years  of  the  regular  educa- 


iloM  drill  in  tree  movrmcnla  and  dcmcniarj 
Itymnusium. 

tional  classes,  men  take  up  specialties  and  devote  themsches  to 
advancer!  Iwxing,  wrestling,  fencing,  or  s-vimming,  or  j.,in  the  crew 
football,  or  baseball  squad.  .\  certain  standard  of  excellence  il 
required  to  get  credit  for  these  siwcialties,  however.  an<l  many  try 
for  the  teams,  and.  failing,  drop  back  into  the  class  work. 

The  following  table  shows  the  distribution  of  men  in  the  dif- 
ferent -ports  and  in  the  gymnastic  classes  at  Pennsylvania: 

Approximate  Distribution  „p  Me.v  Doivo  Rkquirep  Work  in  Hirrr.E-n- 
foRMs  OF  Exercise  Durinc.  a  Coiiege  Ve.ir  at  Pennsylvania. 

Prescriplion  work  for  dcferts  or  dijaliility 

Regular  gymnastic  claaiea 


Re,, 


rting  for  haseliall uc 

baskcl-hall jg 

boxing. 14 

rrew 71 

fencing ,j 

football ,jj 

gun  club 

gymnastic  team 
sot  cer 


7 
16 

QO 

wrestling 8,^ 

ofiQ 


swimming 
track  .... 


Retaini-d  <in  luseball  s<|uacl. 

■'    liasket-ltall  team  . 
"   b.jxing  team . 

"  crew 

"   fen,  ing  team  . 
"   f<K,ihaII  s,juail  . 

"   gun  team  

■■  gymnaslii   icm.  . 
"  soccer  ...        ... 

swimming        .    . 

"        "   track  

wrestling 


,1=0 
oq6 


Total  . 


77 
7 
g 

iS 
jS 
06 

13 


Grand  total. 


r 


II 
I 


•«K»OCO»Y  liSOtUTION  TBI  CHAn 

(ANSI  and  ISO  TEST  CHART  No.  2) 


APPLIED  IN/MGE    Inc 

1653   Eoil   Uain   Street 

Boeh»»t«r.   U*w  rort        t*609       us* 

(716)   482  -  0300  -  Phon. 

(716)   2«a-5989-FoK 


igo 


EXERCISE  IN   EDUCATION   AND   MEDICINE 


ill' 
1  ll 


The  actual  conduct  of  competitive  athletic  sports  may,  to  a  great 
extent,  be  left  in  the  hands  of  the  students  themselves  as  a  part  of 
their  social  training,  but  the  university  should  require  two  things^ 
a  careful  examination  of  the  physical  condition  of  competitors 
before  allowing  them  to  enter  their  name  on  the  squad;  and  a 
rigid  standard  of  scholarship  for  all  who  are  to  represent  the  in- 
stitution in  an  intercollegiate  contest. 

The  number  of  men  who  are  prevented,  by  a  preliminary 
medical  examination  from  endangering  health  or  life,  shows  the 
value  of  this  precaution  wherever  the  more  violent  forms  of  ath- 
letics are  practised,  and  men  sometimes  present  themselves  as 
candidates  for  athletic  teams  who  have  unsuspected  organic  lesions 
of  the  heart,  dangerous  hernias,  or  incipient  tuberculosis,  men  who 
have  no  place  in  the  exhausting  struggle  of  a  game  of  football,  a 
boat-race,  or  a  half-mile  run,  but  to  whom  regular  judicious  light 
exercise  would  have  the  greatest  value. 

The  medical  examiner  should,  of  course,  have  complete  author- 
ity to  decide  on  the  best  course  to  pursue  in  each  case,  and  he  will 
usually  find,  with  added  experience,  that  he  may  permit  many  a 
man  to  engage  in  vigorous  sports,  with  advantage  to  his  health, 
whose  condition  would  be  condemned  by  one  who  went  entirely 
by  the  standard  text-books.  This  question  will  be  more  fully  dis- 
cussed in  the  chapter  on  Disorders  of  the  Circulation. 

The  question  of  scholastic  and  amateur  standing  is  scarcely 
within  the  scope  of  this  chapter,  but  some  universities  require  even 
a  higher  standard  among  their  athletes  than  in  the  general  student 
body,  and  the  tendency  of  most  academic  councils  is  in  the  direc- 
tion of  greater  stringency  in  the  requirements  and  a  more  rigid 
enforcement  of  the  regulations. 

In  rough  games  like  football  there  will  always  be  accidents 
to  deplore.  The  chance  of  a  twisted  ankle  or  knee,  or  even  a 
broken  collar-bone  or  arm  or  leg,  is  one  of  the  things  that  make 
such  games  attractive  to  the  healthy  young  man,  but  if  we  put 
against  these  accidents  the  escapes  that  every  old  player  of  forty 
can  recall  from  an  injury  that  a  clumsy  slow  movement  would  have 
precipitated,  the  balance  will  surely  be  on  the  other  side,  and  the 


PHVSirAL   EDUCAnON   IN   THE   COLLEGE   AND    UNIVERSITY      19, 

permanent  disability  from  accident  is  almost  negligible  in  men 
who,  properly  examined,  and  found  to  be  sound,  are  sent  into 
a  contest  m  good  physical  condition  by  an  adequate  course  of 
trammg. 

Practically  all  colleges  and  universities  that  have  such  a  de- 
partment organized  give  some  instruction  in  the  theory  of  physical 
trammg  and  personal  hygiene,  their  courses  forming  part  of  the 
regular  teaching,  either  elective  or  compulsory,  as  the  special  con- 
ditions  seem  to  indicate,  rnd  the  application  of  exercise  and 
massage  ,n  medicine  and  surgery  now  has  a  recognised  place  in 
every  well-equipped  medical  curriculum. 

A  summer  course,  lasting  six  weeks,  for  students  and  teachers 
of  physical  framing  has  been  given  for  the  last  twenty  years  at 
Harvard.  It  began  with  a  one-season  course,  and  now  extends 
over  three  summers,  and  includes  both  theory  and  practice  and 
summer  courses  are  also  given  at  Columbia  University,  the  Col- 
lege o  the  Cty  of  New  York,  and  at  Chautauqua.  Owing  to  the 
imperfect  and  superficial  training  received  by  most  teachers  of 
this  subject,  these  summer  schools  are  most  valuable  and  de- 
servedly popular. 

In  addition  to  the  supervision  of  the  health  and  the  teaching 
of  the  students,  a  department  of  physical  education  has  unusual 
opportunities  to  promote  original  research  in  the  problems  of 
psychology,  physiology,  and  anatomy  that  confront  it,  and  the 
association  of  other  departments  in  solving  them  should  not  be 
neglected. 

The  taking  of  certain  measurements  from  time  to  time  is 
useful  to  stimulate  in  the  student  a  pardonable  pride  in  his 
expanding  chest  and  swelling  biceps,  but  it  is  also  of  use  to 
detennme  the  proportions  of  the  average  student  and  his  varia- 
tions  from  this  average. 

Hitchcock,  Seaver,  and  especially  Sargent  have  done  pioneer 
work  on  this  subject. 

Dr.  Sargent's  complete  set  of  charts,  containing  th  principal 
measurements  of  students  for  each  year,  from  sixteen  to  twenty- 
five,  and  selections  from  his  statistics  for  the  youth  and  maiden 


igi 


EXERCISE  IN   EDLCATION  AND  MEDICINE 


of  twenty-one,  have  been  embodied  in  two  life-size  statues, 
modelled  Ijy  Henry  H.  Kitson,  showing  the  meilium  measure- 
ments for  that  age. 


FlQ.  143. — The  ideal  college  athlete. 
(Copyright,  R.  Tait  McKenzie.) 

The  variations  from  that  type  have  been  noted   by  Paul  C. 
Phillips    in    his    observations  of    splinters,"    by    the  author    in 

'  "Outing,"  J'ay,  rgoj. 


ravSICAL   EDrCATIOX   IN   THE   COLLEGE   AND    fmVERSITV      ,93 

Athlete.'-  '  ""'   "'''^■^'■"'    Characteristic,  of  ,he 

.  7''"  ^"^''  '"  ^  f'-y'*'^""  ideal  was  undertaken  by  the  So- 
ciety of  Directors  of  Physical  Education  in  Colleges,  who  t 
I902,  commissioned  the  modelling  of  a  statuette  emlxxlying'ihe 
average  measurements  and  pro,»rtions  of  the  pick  of  the  studen 

sS'tfrfr  '  '''"'-'  '"^  '"'  '"'"^  ■"-  '"  ">^  '"'-ound 
^  ength  test  for  a  period  of  eight  years.  These  four  hundred 
«^ts  of  measurements  of  Hanard  students,  supplied  by  Dr 
Sargent,  were  used  to  determine  the  pro,K,rtions  of  the  ''ideal 

rtT'h'd  ;r'   ^■'■"'''  ^^■'^"--P-omed  as  placing  in, 
right  hand  the  spring  dynamometer  with  which  he  is  about  to 
test  his  grasping  muscles. 

girths  of  the  physically  ideal  .American  student  of  twenty-two 

With  a   height  of    5   feet  9   inches,  he  carries  a   weight 'of    1 
m  pounds     The   girth  of    his  neck,   knee,  and  calf  ^e  thj  / 
same,  w        the  upper  arm  i}  inches  less.      The  girth  of    his 
high  ,s  J  ,nch  less  than  that  of  his  head.     His  expanded  che      ' 
..  40  inches  and  the  girth  of    his  waist  is  ro  inches  less.     H K 
b  eadth  of  h  ■":  "r  ''  '"  ™-''P-ded  chest,  while  the 

S  stlh  of 'I- ™'       '"''  """'^  "'^'  '-^"^"^  °f  his  foot,  and 
the  stretch  of  his  arms  measures  .  inches  more  than  his  height. 

'.  ".1"^"^'"  Sf.tan™  Monthly,"  Decemlier,  100; 
Scnbners,"  July  and  -N'.ivemlier,  1S87.   ^  ^ 


m 


CHAPTER  XII 

THE   PHYSICAL   EDUCATION   OF  THE  BLIND  AND 
THE  DEAF-MUTE 


Havino  described  the  physical  education  of  the  normal  child 
from  infancy  to  maturity,  there  remains  only  a  description  of  the 
modifications  required  for  the  training  of  those  unfortunates  to 
whose  minds  the  avenues  of  sight  and  hearing  are  closed;  and  of 
those  others  whose  minds  are  flulled  or  who  have  already  taken 
the  first  steps  in  the  path  that  leads  to  the  penitentiary  or  the  mad- 
house. 

Since  the  world  of  the  blind  is  limited  by  the  horizon  made 
by  the  reach  of  his  arms,  his  suprcmacj'  within  this  circle  must  be 
suoreme. 

Physical  education  does  him  a  triple  service  by  increasing 
the  couidc;  and  confidence  which  he  so  sadly  lacks  by  develop- 
ing hi:i  muscular  powers  and  by  fortifying  his  body  against  those 
infirmities  to  which  enforced  idleness  and  a  sedentary  hal)it  render 
him  peculiarly  prone. 

It  is  within  comparatively  recent  years  that  the  physical  educa- 
tion of  the  blind  has  been  studied  with  care,  and  that  methods 
have  been  adapted  to  their  possibilities  and  limitations. 

The  m.ost  striking  characteristic  of  the  blind  child  is  a  certain 
timidity  or  fear  of  appearing  at  a  disadvantage  before  others,  es- 
pecially in  making  an  unaccustomed  movement,  so  that  the  only 
exercise  they  undertake  voluntarily  is  walking  backward  and  for- 
ward in  some  confined  i)lace  with  which  they  are  familiar.  They 
are  liable  to  sit  still  for  long  periods  of  time,  and  usually  develo]) 
certain  rhythmic  habi;  movements  of  the  head  and  hands,  difficult 
to  repress  and  correct. 

They  must  either /iW  or  limr  a  movement  in  order  to  learn  it. 


P«VS.CAL   K.,.CA„OX   OK   THE    BU.vn   .^„    THE    nE.r-„CT.     xgj 


for  they  have  not  the  mirror 
of  their  companions  from 
which  to  correct  faults  j..  their 
own  posture  or  action. 

fn    the    measurement    of 

boys  at  the  Overbrook  School 

for    the    Blind    it  was  found 

that  their  height,  weight,  and 

lung  development  were  under 

the   average   of  normal   Ijoys 

of   the   same  age,  as  shown 

in  the  Sargent  charts  (Allen). 

The  blind  lK)y  has  thus  even 

a  greater    need    for    physical 

training  than  the  boy  who  can 

see. 

In  many  blind  children  ex- 
ercise must  begin  with  the 
.simplest  acts,  such  as  dressing 
and  undressing,  which  have 
been  neglected  in  many  homes 
where  the  blind  child  is  waited 
on  and  not  trained  in  move- 
ments that  make  for  accuracy 
and  tidiness. 

A  course  must  pay  special 
attention  to  the  imjTOvement 
of  posture  in  walking,  stand- 
ing, and  sitting,  for  the  blinrl 
walk  with  the  head  inclined 
forward,  the  chest  contracted, 
and  usually  come  down  hard 
upon  their  heels  at  each  step, 
and  it  must  embrace  free  mo\e- 
ments  for  the  chest,  arms,  an<l 
shoulders,  including  all  possi- 


196 


EXERCISE    IN    EDICATION   AND  MEDICINE 


ble  games  and  other  forms  of  reaction  that  can  be  conducterl 
with  safety  and  al)anilon. 

The  chief  difficulty  in  a  course  is  the  cultivation  of  that 
l)hysical  confi<lence  necessary  for  success  in  active  s|K)rts  like 
running,  jumping,  anil  gymnastics. 

Various  devices  are  rcquiretl  in  the  construction  of  the  gym- 
nasium and  field  to  prevent  accidents  and  to  foster  freedom  of 
movement.  The  gymnasium  hall  should  be  constructed  with  a 
wooden  Hoor,  surrounded  by  a  band  of  cement  seven  feet  wide, 


1 

' 

i 

, 

Fic.  145. — The  cock-fight  and  other  {tymnaatic  Karnes.  The  band  of  concrete  at 
llie  etlge  of  the  floor  is  also  shown.  (Pennsylvania  Institution  for  the  Instntction  of  the 
Blind,  Overbrook,  Pa.) 

on  which  all  the  heavy  apparatus  should  be  placed  when  not  in  use 
(Fig.  145).  In  this  way  a  blind  jjerson  is  made  aware  of  his  ap- 
proach to  the  wall,  and  of  the  presence  of  danger,  when  walking, 
running,  dancing,  or  skating.  .\  running  track  should  have  a 
hand-rail  of  convenient  height  to  serve  as  a  guide,  and  in  the  play- 
fields  the  presence  of  trees  should  be  shown  by  having  a  brick 
walk  about  ten  feet  in  front  of  or  around  them,  so  that  the  child 
may  run  and  play  with  perfect  freedom  and  confidence  until 
warned  of  the  approach  to  danger  by  the  bricks  under  foot 
(Fig.  144). 


Pi.VS,CAt   KOUCAT.ON   OF   THE    BL.NO    ANB   T.„:    OKAF-MrTE     .97 

Outdoor  apjamtu,  should  also  be  fixed,  the  child  «>on  learninK 
hnr  place  and  avoiding  ,he  collisions  ,ha.  woul.l  ine,i,ably  occur 
if  their  |)osition  were  a  matter  of  conjecture 

Physical  e.lucation  for  the  blind  shoul.l  be  cmnulsory  at  all 
ms  itutions  as   it   is  at  Overbrook,  Pa.,  the  classe    bcTn«    1 
and  arranged  ,n  the  order  of  their  a«e,  an,;  „i,h  some  part^Hy 
bliml  pupils  mixed  with  the  totalU  blind  to  act  as  leaders     The 

ZTZt  "of"  vtr  '"  "It''-^"'"''^'""'  "-•  ""'  'l»T-  very  much 
hn  ..  t.  ""  "■'"'  '*'"•  ""'■'  "^'"  '•"  linins  up  they 

should  keep  in  .ouch  with  one  another  by  each  pupil  facing   he 


'I   I 


'■P^- 


y-'^'-'-ftm 


Fig. 


M6.-M«hod  of  alignment  in  .  d„,  „(  ,h.  blind  in  Sweden  (I.efebure). 


hand  on  the  shoulder  of  the  one  in  front,  or,  where  a  class  is 
formed  up  in  ranks,  by  placing  the  right  hand  on  the  cmpanL' 
sh^lder^and  the  left  hand  on  the  waist,  as  is  done  i7wen 

When  a  number  are  lined  up  in  single  file  a  regular  class 
formation  can  be  obtained  without  difficulty  by  giving  the  o'dl 
"ngh  turn,  and  counting  off,  and  this  can  easily  be'reversed  o 
the  original  line-up  when  the  exercises  are  over 

Gymnastic  apparatus  work  may  be  used  with  considerable 
advan^ge,  but  the  leader  should  be  able  to  see  a  little  and  mem 
bers  of  the  class  must  learn  the  movement  by  passing  theZd 


S   1_ 

'■■4 


198 


KXERCISK   IX   tlHCATtON   AND  UEnlCISK 


over  the  Itadtr  while  he  is  doitiK  it.  By  this  means  a  wide  range 
of  work  can  Ik:  ilonc  on  the  horse  an<l  parallel  bars,  anfl  such  ex- 
ercises as  falling,  rolling,  and  simple  tumhlin;,'  may  he  extensively 
developed,  hut  the  Swedish  system  of  gymnastics,  in  which  the 
exercise  is  performed  in  rcs|)onse  to  command,  must  he  used 
sparingly,  hecause  of  the  Rreat  and  rapid  mental  exhaustion  pro- 
duced in  blind  children. 

Formal  gymnastics  and  apiaratus  work  should  play,  however, 
a  comparatively  small  rfile  in  their  day's  exercise,  and  games  should 


m 


FiR.  147-— 'oo-yard  d.Tsh.  St.irt,  showinR  handles  .ind  cables  to  direct  their 
cours.-.  Overbroolc  re.„rd,  lol  seconds  (Pennsylvania  Institution  for  the  Instruction 
of  the  Blind,  Overbrook,  Pa.). 

be  freely  interspersed  when  symptoms  of  exhaustion  appear. 
Among  the  most  popular  games  are  the  cock-fight,  and  a  game 
invented  at  Overbrook  by  Lindblad,  called  the  Japanese 
torpedo,  in  which  a  small  bag  of  sand  covered  by  emery  cloth  is 
attached  to  a  long  string,  and  swung  around  in  a  circle  by  one  pupil 
while  the  others  Jump  o\cr  it  as  it  passes,  being  guided  by  the  sound 
of  the  emery  cloth  on  the  floor. 

Running,  roller-skating,  and  dancing  can  also  be  practised  if 


PlIVSICAL    KDL'CATION    OF   TIIK    BlIMl    AND    TIIK    DKAr-UlTK 


I<» 


romparaiivilv  fiw  skai.rs  or  iliincirs  arc  allowtil  nn  the  ll(x)r  at 
one  time,  and  all  arc  required  to  circle  in  one  direction  only,  the 
presence  of  the  concrete  margin  on  the  tloor  IxinR  sufficient  pro- 
tection when  heavy  apparatus  is  carefully  put  liack  in  its  place 
against  the  wall  after  class  use.  Another  |)rotection  against  run- 
ning into  the  wall  is  the  changed  resonance  due  to  the  presence  of 
the  running  track,  a  ])hcnomenon  which  the  i/lind  use  continually 
for  their  protection. 


Fir.  148.— roo-yard  dash.  Finish.  Thf  racers  are  able  to  give  unhamjicrcd 
attention  to  speed  t)y  means  of  the  device  shown  aliove.  L'ljon  the  wire  cables,  stretched 
the  full  lenKth  of  the  track,  are  rings  to  which  are  attachetl  short  chains  and  handles. 
The  racers  hold  these  handles  and  run  the  course  with  perfect  frc-eilom.  Thi-y  arc- 
warned  of  the  end  of  the  track  by  th»  fringe  of  cords  like  that  used  on  railroads  to  notify 
brakemenon  top  of  f rciRht  cars  of  " low  bridRcs"  (Pennsylvania  Institution  for  ti,  ■  In- 
struction of  the  Blind,  Ovcrbrook,  Pa.). 


.Vmcng  the  outdoor  sports  walking  is  almost  the  only  one  blind 
children  will  \  .untarily  undertake,  although  they  can  be  taught 
almost  all  the  ileld  sports,  with  but  few  restrictions. 

Clarence  E.  Van  de  Walker,  the  instructor  at  Overbrook, 
writes  on  this  subject: 

"To  me,  watching  and  directing  this  work  from  day  to  day, 
the  sight  of  strong,  active  boys  learning  to  run  in  much  the  same 


JM 


100  EXEICMK  IS   KDICATION  ,'\li  UKIllrlNE 

way  that  a  baby  learns  to  walk,  and  cxiwriincinK  ahmt  the  same 
difficulties,  was  l)oth  amusing  and  pathetic;  but  the  smile  and  shout 
of  triumph  which  burst  forth  simultaneously  from  the  Iwy  who  had 
succeeditl  in  really  running  were  aiipic  proof  of  his  delight  to 


Fig.  149- — Rlind  hoy  preparing  to  jump. 

discover  that  he  possessed  a  power  dormant  so  long  that  he  doubted 
its  existence." 

Foot-racing  was  practically  impossible  until  the  invention  of  a 
method  in  one  of  the  institutions  of  Edinburgh,  by  which  a  three- 
stranded  cable  as  light  as  was  consistent  with  strength  was  stretched 
breast  high  between  well-guyed  end-j.osts  no  yards  apart.     The 


HIV8K-A1.    KI.ICUION    .,  •   TlIK    BMM)    AM,    TIIK    hKAKlHTK     JOI 

runner  h.J.ln  in  one  hand  a  wcolcn  han.lle  altachcl  l>y  a  short 
flfxi  .lu  chain  t.,  ihc  lonx  wire.  As  he  runs  the  rin«  shps  alon^  an.l 
the  feehnK  an.l  sound  enable  him  to  hol.l  his  lourse.  At  the  end 
of  the  too  yards  a  cord  is  stretched  across,  alx>ut  sl•^en  feet  lii;;h, 
from  which  han^s  a  fringe  of  hammock  twine  lon^  enough  to  sir?kc 
the  rimner  in  the  face  as  he  passes.  This  fringe  covers  the  two 
lurallel  lanes,  so  that  competitors  may  run  in  pairs,  an<l  prevents 
those  accidents  that  were  at  best  too  frcjuent  in  the  .,|«;n  Held 


Fig.  ■,o.-Pwii„B  ll»  .h„>  („  lb..).    Owrbr^k  record,  j,  ft.  ,J  ,„.  ,Pe„„,y|va„ia 
Iralilulion  for  Iht-  Inmruclion  o(  Ihe  Mind,  Overbroolc,  Pa.). 

Even  the  running  broad  jump  may  lie  practised,  the  measure- 
ment being  made  from  the  starting  foot  instead  of  from  a  fixed 
board. 

Other  popular  field  sports  are  putting  the  shot,  throwing  the 
discus,  and  throwing  the  hammer-with  a  stiff  wooden  handle  and 
thrown  from  a  stand. 

A  strange  phenomenon  for  the  psychologist  is  the  [wpularity 
of  a  modified  form  of  baseball,  in  which,  at  a  signal,  the  pitcher 
throws  the  ball,  the  batter  strikes,  and  the  catcher  catches.  As  a 
rule,  no  one  accomplishes  anything  but  the  pitcher,  and  vet  boys 


20S  EXKRCISE  IN    EDUCATION  AND  MEDICINE 


^ 


ill 


Fig,   151.— The  swimminR  pool   (Pennsylvania  Institution   for  the  Instruction  of  the 
Blind,  Overbrook,  Pa.). 


Fig.   15a. — TrolIeycoastinR  on  the  athletic  field  {Pennsylvania  Institution  for  the  Instruc- 
tion of  the  Blind,  Overbrook,  Pa.). 


PHYSICAL    EDUCAHON   OF    THE    BLIND   AND   THE    UEAF-ML'TE 


t 


20J 


•i^rw^: 


m 


1    I 

Hi 


FW-  .SJ.-King    B«mt.     Kind.rgarlen    building    in    Ihe    background    (Penn,vlvania 
insutution  for  the  Inslruclion  ot  the  Blind,  Overbrook,  Pa.). 


Fig.  ,54._A  game  ot  "blind  mans  buff"  in  the  girls  cloister  (Pcnns.vlvania  Institution 
for  the  Instruction  of  the  Hlind,  Overbrook,  Pa. ). 

will  play  this  for  iiours  at  a  time.      Football  is  also  played  In-  choos- 
ing sides  and  kicking  the  ball  back  and  forth  until  the  goal-line  of 


:M(il 


304 


EXERCISE   IN    EDUCATION   AND   MEDICINE 


one  side  is  crossed.     This  is  also  popular,  and  can  best  be  done  by 
choosing  one,  at  least,  on  each  side  who  has  partial  sight. 

Swimming  is  an  excellent  exercise  for  the  arms  and  shoulders, 
and  is  practised  with  success  among  the  blind. 


Fig.  rsS- — Rocking-hoat   (Pennsylvania  Institution  for  the  Instruction  of  the   Blind, 
Overbrook,  Pa.). 

.\thletic  sports  are  quite  as  popular  among  the  girls  as  they  are 
among  the  boys.  They  enjoy  jumping  and  running,  and  athletic 
and  gymnastic  apparatus,  like  the  trolley-coaster,  swings,  and  see- 
saws, should  be  provided  for  them  in  the  gymnasium  and  out-of- 


PHYSICAL   EDUCATION    OF   THE    BLIND   AND   THE   DEAF-MUTE     205 

doors,  while  the  rocking  boat  is  safe  and  an  endless  source  of 
pleasure  to  the  younger  children. 

The  Deaf-mute. — A  system  of  physical  training  designed 
for  deaf-mutes  must  take  into  consideration  the  peculiarities  in- 
cident to  deafness  that  divide  them  from  the  rest  of  humanity  into 
a  class  by  themselves.  And  it  must  also  bear  in  mind  the  fact  that 
in  almost  every  respect  they  resemble  other  children.  A  deaf 
child  thinks  in  gesture  and  pictures,  and  so  expresses  his  thoughts, 
but  his  verbal  memory  is  undeveloped.  His  chest  and  all  the  ap- 
paratus of  articulation  are,  in  consequence,  under  the  average,  and 


ifl 


";' 


Fig.  156. — Deaf-mutes  playing  basltel-ball. 

they  are  peculiarly  liable  to  disorders  of  the  respiratory  tract  accom- 
panying this  underdevelopment. 

In  girls  of  sixteen  one  series  of  observations  by  Miss  Grace 
Green  showed  an  average  lung  capacity  of  118.3  cubic  inches,  as 
compared  with  130  cubic  inches  of  the  normal  girl  of  the  same  age. 

Their  powers  of  coordination,  particularly  of  equilibrium, 
are  not  up  to  the  normal,  and  they  have  a  peculiar  characteristic 
slouch  of  the  figure  and  a  shuffling  gait. 

Physical  education  would  then  include  and  emphasize  the 
teaching  of  articulation,  which  is  an  art  by  itself;  the  develop- 


Mii 


^1 


306 


EXERCISE   IN   EDUCATION  AND  MEDICINE 


I 


ment  of  the  respiratory  system;  the  cultivation  of  balance  and 
the  correction  of  postural  defects. 

The  education  of  the  deaf  is  carried  on  better  in  an  institution 
than  at  home,  and  as  the  great  majority  of  such  cases  come  from 
the  poorer  classes,  and  have  to  be  made  as  efficient  as  possible 
as  wage-earners,  I  shall  write  more  particularly  of  institutional 
work. 

No  formal  drill  should  be  given  to  the  very  youngest  pupils, 
who  have  no  "language,"  but  ga ncs  and  free  play  seem  to  suit  them 
best.  To  the  class  next  youngest,  whose  language  is  limited,  worlc 
should  be  given  by  word  of  command,  followed  by  the  execution 
of  the  movement,  which  the  children  imitate.  In  this  way  the 
movement  of  the  lips  is  associated  with  the  exercise,  and  the  child 
■s  trained  to  read  the  lips  In  such  wise  as  to  learn  the  response  to 
the  command  without  further  demonstration. 

Thi-  teaching  of  lip-reading  is  part  of  the  instruction  in  every 
institution  for  deaf-mutes. 

The  last  census  of  the  United  States  shows  that  of  89,287  deaf, 
only  13,986  could  r^ad  the  lips,  and  speech-reading  was  confmed 
almost  entirely  to  thfe  totally  deaf,  since  the  partially  deaf  or  those 
who  have  acquired  deafness  in  later  life  do  not  learn  it,  but  depend 
on  the  use  of  some  device  like  the  ear-trumpet  in  preference. 

.-Vbout  39  per  cent,  of  the  totally  deaf  have  been  taught  lip- 
reading  at  institutions  like  Mount  .\iry.  Pa.,  and  elsewhere,  and 
as  every  means  is  taken  to  practise  the  children  in  this  art,  physical 
training  gives  valuable  opportunities. 

In  the  more  advanced  grades,  as  their  language  ,ecomes  better, 
the  significance  of  the  command  is  apprehended  and  its  full  meaning 
realized.  Exercise  bv  word  of  command  is  then  of  double  value 
for  deaf-mutes,  since  it  teaches  lip-reading  and  trains  their  verbal 
memory.  There  are  two  things  to  be  remembered,  however,  in 
teaching  a  class  of  deaf  children.  The  teacher  must  always  be  in 
front  of  the  class,  on  a  platform  elevated  at  least  one  foot  above  the 
floor,  so  that  each  pupil  may  have  a  clear  view  of  her  mouth  with- 
out having  to  lose  the  correct  attitude  in  standing.  Commands 
for  marching  and  turning  movements  must  always  bring  the  class 


PHYSICAL   EDUCATION   OF   niE    BLIND  AND   THE   DEAF-MUTE     .07 

back  ,0  a  position  facing  the  platform,  as  the  pupils  have  only  the 

tha       e  1  ;      U       r-""""^^  ^''''"'''  •'^  «'™"  ""h  f""  force,  so 
that  the  natural  facial  expression  may  be  maintained.    This  while 
an  advantage,  is  not  essential,  as  I  have  repeatedly  seen  I  djs 
respond  promptly  and  accurately  to  a  command  given  by  the  i, 
only  without  any  sound.  ^  ' 


oquil,bnum,  in  the  foreground.  "'"inu 

The  shuffling  gait  and  bad  posture  are  corrected  by  setting-up 
exercises,  taken  in  the  standing  and  sitting  positions,  else 
attention  should  be  given  to  the  correct  carriage  of  the  head  and 
shoulders;  to  the  rhythm  and  length  of  the  stride;  to  the  position  of 
the  feet  and  the  distribution  of  the  body  weight. 

Balance  movements  are  most  useful  for  encouraging  a  better 
«,uilibnum  and  improving  the  manner  of  walking,  requiring,  as 
they  do,  a  high  degree  of  coordination.     Whether  a  lack  of  coor 


f'P 


'         -      i 

1 


308 


EXEECISE  IN  EDUCATION  AND  MEDICINE 


dination  and  equilibrium  is  or  is  not  a  direct  result  of  deafness  is 
not  proved,  although  in  many  cases  it  would  appear  to  be  the  case. 

In  a  series  of  experiments  conducted  by  Miss  Grace  Green,  at 
Mount  Airy,  60  pupils  were  chosen  from  the  intermediate  depart- 
ment of  the  institution  on  account  of  their  untrained  sense  of  equi- 
librium. From  this  number  16  were  excluded,  classed  as  semideaf. 
Of  those  remaining,  37  were  congenitally  deaf  and  17  were  semi- 
mutes.  Of  the  27  congenitally  deaf,  30  could  sustain  equilibrium 
with  little  difficulty  and  7  could  not,  while  of  the  17  semimute,  only 
a  were  able  to  keep  in  balance. 

It  is  also  worthy  of  note  that  of  the  44  cases,  32  were  unable  to 
maintain  equilibrium  on  the  balance  beam  or  board. 

These  experiments  emphasize  tHe  importance  of  balance  ex- 
ercises in  the  training  of  the  deaf,  for  they  rapidly  respond  to  sys- 
tematic training. 

Deaf-mutes  do  not  compare  favorably  with  hearing  people  in 
the  matter  of  longevity. '  They  die  in  a  larger  proportion  from  dis- 
eases due  to  bad  feeding,  poor  housing,  and  unsanitary  conditions. 
Mouth-breathing  is  exceedingly  common  among  them,  and  there 
is  a  high  mortality,  due  to  chronic  affections  of  the  respiratory 
tract.  Great  emphasis  should  thus  be  laid  upon  good  food,  warm 
clothing,  the  cultivation  of  speech,  and  the  use  of  respiratory  exer- 
cises, both  free  and  by  the  aid  of  apparatus. 

It  is  to  be  remembered  that  one  of  the  chief  characteristics 
of  the  deaf  is  the  lack  of  speech.  The  hearing  child  who  is  laughmg, 
singing,  and  shouting  in  his  play  all  day  is  unconsciously  giving 
to  the  lungs  one  of  the  most  healthful  exercises.  The  power  of 
speech  is  a  great  incentive  to  the  use  of  the  lungs,  and  the  ac- 
quirement of  speech,  one  of  the  first  things  that  should  be 
taught  the  deaf  child,  can  be  greatly  aided  by  exercises  of  deep 
breathing,  together  with  movements  of  the  arms,  chest,  abdomen, 
and  lateral  trunk,  with  special  training  in  tone  production  and 
control  of  the  respiration.  The  patient  is  thus  given  increased 
power  to  resist  disease,  and  acquires  better  speech  through  this 
development  of  the  entire  respiratory  tract. 

Miss  Green  has  shown  at  Mount  Airy  a  rapid  and  gratifying 


PHYSICAL  EDUCATION  OF  THE  BUKD  AND  THE  DEAF-MUTE    309 

increase  in  the  chest  capacity  of  the  girls  of  that  institution  under 
the  influence  of  physical  training  and  Instruction  In  articulation. 
Her  pupHs  showed  an  average  lung  capacity  of  118.3  cubic  inches 
on  entrance,  In  comparison  with  the  average  130.3  for  normal  glrU 
of  the  same  age.  With  training  the  average  was  raised  to  139.6 
cubic  Inches  from  one  season's  work. 

Games  and  play  are  used  freely,  both  to  relieve  the  tedium  of 
the  more  formal  gymnastic  work  and  to  give  that  development 
which  can  be  produced  by  free  pUy  alone.  They  differ  little 
from  the  pUys  of  the  normal  child,  and  shouTd  be  designed  so  as  to 
involve  the  actions  of  large  muscle  groups,  training  the  children 
in  alertness,  decision,  and  accuracy. 

For  boys  and  young  men  all  the  games  and  sports  of  the  normal 
child  are  available,  and  it  Is  not  uncommon  to  see  the  football  or 
basket-ball  team  of  such  an  institution  taking  Its  place  with  that  of  a 
preparatory  school  or  college  of  the  same  size,  although  the  silence 
with  which  they  pUy  forms  a  striking  contrast  to  •  nrise  of  their 
opponents. 


CHAPTER  XIII 

PHYSICAL   EDUCATION  OF  MENTAL  AND  tlKXtAL 
DEFECTIVES 

It  is  during  the  early  years  of  school  life  that  the  condition 
known  as  mental  dulness,  backwardness,  arrested  development, 
or  feeble-mindedness  develops  sufficiently  to  be  capable  of  definite 
diagnosis.  It  is  there  also  that  the  first  steps  can  be  taken  to  correct 
mental  sluggishness  and  to  train  'the  neuromuscular  system  of 
these  atypical  children. 

The  backward  child  is  always  much  older  and  bigger  than  the 
children  of  his  class,  hopelessly  behind  in  his  standing,  usually 
remaining  two  or  three  years  in  the  one  grade,  and  sometimes 
promoted  only  when  the  desks  and  seats  of  the  room  have  become 
too  small  for  him. 

.\ny  child  that  is  not  able  to  profit  by  the  ordinary  methods 
of  instruction  given  to  the  other  children  of  his  age  should  be  con- 
sidered backward  or  defective,  and  all  such  cases  should  be  carefully 
observed,  and  a  record  of  their  habits  and  mental  characteristics 
should  be  made  in  codperation  with  the  medical  inspector,  or,  if 
necessary,  with  an  expert  on  mental  conditions.  A  thorough  ex- 
amination should  be  made  of  the  special  senses  and  throat;  ade- 
noid growths  where  found  should  be  removed,  and  defective  vision 
or  hearing  corrected.  The  removal  of  these  remediable  obstruc- 
tions is  frequently  sufficient  to  permit  the  backward  child  rapidly 
to  regain  his  normal  grade  standing. 

Mental  dulness  may  be  due  also  to  physical  weakness  following 
severe  illness,  or  to  other  curable  conditions  that  may  not  have  been 
recognized  by  the  parent  or  family  physician.  Again,  certain 
children  in  good  physical  health  develop  slowly  at  certain  stages, 
afterward  catching  up  with  their  fellows.    This  may  be  due  to  a 


PHYSICAL   EDUCATION   OF   HENIAL   AND   MORAL  DEFECTIVES      21, 

period  Of  rapid  physical  growth,  and  shouW  t«  carefully  distin- 

yeat  Wh'e^  ,h""  \  '™'""  *»"-"y  backward  for  several 
years.  When  they  wake  up,  as  they  eventually  do,  they  frequently 
show  unusual  ab.lity.     When  these  cases  are  accounted  Tor,  and 

^mLl?r  """T""  t"""^  "  '""'°™'""y  ""'"i.  'her;  still 
remains  a  group  of  pup.ls  who,  while  not  actually  idiotic,  are 

so  deficient  mentally  as  to  be  entirely  incapable  of  profiting  by 
ordmary  school  methods.  ^    ^ 

Fr»i"-  w  ™'"'"'"™  °f  •<»'«»  London  school-children.  Dr. 
Francis  Warner,  m  .8go,  showed  over  .  per  cent,  of  actual  mental 
defectives,  and  similar  investigations  show  that  this  ratio  holds  good 
in  America.  '  * 

The  symptoms  of  mental  deficiency  are  characteristic.     Back- 

oulklv  Th"  "'  '""■'""l''^  ""^  """•*'  '^""'  "■«'  l™"  '-"'"est 
qmcky.     They  are  not  observant,  are  not  able  to  discriminate 

K;';  r"'"'"'  '"'"'•  '"""'  "^  ^''^^-  They  may  be  unduly 
.dk  and  lis  less  or  overexcitable.  They  are  often  disobedient; 
wdful,  and  liable  to  attacks  of  stubbornness  and  bad  temper 
They  are  untidy  in  their  personal  habits  (Femald),  awkwarcHn 
heir  gait  movement,  and  attitude.  In  grasping,  they  are  either 
feeJe  or  they  may  clutch  the  object  and  seem  to  be  unable  to  let 
.t  go.  Incoordination  is  plainly  shown  in  drawing  and  writing,  in 
the  lack  of  ,k,ll  and  dexterity  in  simple  gymnastics,  and  in  the 
lack  of  initiative  and  spontaneity.  They  do  not  show  the  strength 
vigor,  alertness,  and  courage  of  normal  childhood. 

When  a  diagnosis  has  been  made,  the  i«rents  should  be  frankly 
and  tactfully  taken  into  the  teacher's  confidence,  the  use  of  op- 
probrious terms  to  express  mental  defectiveness  being  carefully 
avoided.  The  parent  should  be  impressed  with  the  fact  that  the 
child  IS  not  doing  well  at  school  and  that  for  his  own  sake  he  should 
have  special  attention  to  prevent  him  from  going  backward,  as  well 
as  to  tram  to  the  best  advantage  such  jMwers  as  he  has 

aight  ca^  of  backwardness  may  be  taught  in  classes  com- 
P^  of  children  who  show  about  the  same  degree  of  retardation 
while  pronounced  and   incurable  cases  are  much   better   safe- 


til  EXCKCUE   IN   EDl-CATION   AND   MEDICINE 

guarded   in  an  institution  where  they  can  be  more  closely  ob- 
ser\ed  anf  protected. 

The  physical  education  would  then  vary  with  the  degree  of 
the  defect  and  with  the  amount  of  control  exercised  by  the  teacher. 

In  a  school  system  special  classes  should  be  provided  for  them, 
and  teachers  should  be  specially  prepared  to  Uke  charge  of  these 
atypical  pupils.  Public  schools  for  them  have  been  in  successful 
operation  in  Germany,  Norway,  Sweden,  Denmark,  France, 
Switzerland,  and  England.  In  London  alone  there  are  more  than 
5o  classes,  and  such  classes  are  also  in  successful  ojieration  in 
Philadelphia,  Providence,  Boston.  Chicago,  and  elsewhere. 

Backward  children  are  segregated  for  their  own  benefit,  and 
also  for  the  benefit  of  the  other  pupils  of  the  school  whom  they 
would  hold  back.  The  classes  should  be  small— not  over  15 
in  number — and  great  attention  should  be  paid  to  improving 
the  child's  surroundings  in  the  home  as  well.  His  physical 
condition  should  be  kept  as  favorable  as  possible  by  nourish- 
ing food,  regular  outdoor  exercise,  bathing,  ample  sleep,  and 
careful  attention  to  bodily  functions  and  habits.  The  mental 
awakening  resulting  from  an  improved  state  of  nutrition  and 
bodily  vigor  alone  is  often  striking.  The  education  of  the 
special  senses  and  the  training  of  the  voluntary  muscles  to 
prompt  and  accurate  response  must  precede  and  prepare  the  way 
for  the  more  purely  intellectual  training.  The  unseeing  eye,  the 
unhearing  ear,  and  the  other  obstructed  avenues  of  approach  to 
the  central  intelligence  must  be  opened  up  by  a  series  of  carefully 
arranged  "sensorial"  gymnastics.  The  ultimate  aim  of  these 
exercises  is  to  train  the  child  to  acquire  knowledge  from  his  sen- 
sations. Next  in  importance  comes  the  discipline  c»  the  muscles, 
not  only  for  muscular  growth  and  practical  coordination,  but 
particularly  with  reference  to  the  well-recognized  relation  of 
thought  to  muscular  movement,  motor  training  being  one  of  the 
most  potent  factors  to  arouse  the  feeble  powers  of  voluntary  at- 
tention, observation,  and  comprehension.  This  motor  eflucation 
should  begin  with  the  common  games  and  occupations  of  normal 
childhood.    The  child  should  be  taught  to  throw  and  catch  a  ball. 


PHV8IWI  EDUCATION  OF  MENTAL  AND  IIO.AI   DEfFXTIVES     ,13 

to  kick  .  foot-b.ll,  to  jump  and  run.  and,  in  fact,  to  p^form  larger 
movement.  cUinR  for  the  natural  u.«  of  the  various  mu«:le  Rroum 
progressing  with  an  eye  to  the  normal  evolution  of  the  play  in- 
stmct  as  .lescribe.1  in  the  chapter  on  Age  and  Occupation. 

-Vf  ic  and  rhythmic  marching  are  preferable  to  more  fort,  al 
gymnastics,  involving  close  and  continu-d  attention,  prom..i 
obedience,  and  accurate  motor  response.  The«  ,,ualities  1st  ',e 
cultivated  by  the  simplest  movements  at  first  or  the  goo.]  effect  wl 
be  lost.  Gymnastics  by  commands  would  at  first  be  entirely 
beyond  most  of  these  children,  whose  attention  would  quickly  lag 
and  whose  cofi,«ration  and  interest  it  would  .e  impossible  to 
maintain. 

What  has  been  said  of  general  motor  training  applies  with  s,«cial 
force  to  the  training  of  the  f.  ,er  coordinations  of  hand  and  forearm 
rhis  can  best  be  done  by  kindergarten  methods  and  by  manual 
occupations,    such   as   Sloyd,    basketry,   and    weaving.     Indeed 
here  are  no  other  means  of  influencing  so  profoundly  the  men- 
tal  growth   of  the  defective.      Instruction   must  always   tegin 
on  a  very  low  plane  and  progress  at  best  will  be  slower  than  in 
he  normal  child.    .\t  an  early  age  much  of  this  neuromuscular 
training  by  gymnastics  may  be  directe.1  to  the  various  handicrafts 
and  simple  manual  labor  which  will  enable  many  of  these  children 
especially  m  institutions,  to  become  self-.upporting  in  after-life' 
who  would  otherwise  become  a  burden  ou  the  community.    Under 
this  course  of  education  some  children  develop  up  to  the  grade 
classes  and  retutr,  to  them,  completing  a  fairly  satisfactory  school 
course.     When,  however,  the  degree  is  extreme  an.l  the  condition 
is  congenital  or  the  result  of  disease  or  injury,  these  brain  abnor- 
mahties  remain  permanent  conditions,  and  no  really  feeble-minded 
person  was  or  can  be  entirely  cured  (Fernald). 

It  is  always  a  question  of  how  much  improvement  is  possible 
m  each  individual  case.  Many  of  them  may  be  trained  to  be  at 
least  self-supporting,  if  not  self-controlling,  but  the  greater  number 
need  oversight  and  supervision  as  long  as  they  live.  A  large  pro- 
portion become  public  charges,  and  it  is  important  that  they  be 
kept  m  institutions  as  they  approach  adult  life,  that  they  may  not 


i  i 


»M 


EXEKCUE  IN   EDirCAnON  AND  MEDlrlNE 


have  an  opportunity  to  yield  to  the  physical  tcmputlons  to  which 
they  are  ao  |)cculiarly  susceptible,  and  so  pro|>OKatc  their  own  kin<l. 

Cases  of  gross  lefcct  arc  always  Iwttcr  treated  in  institutions 
than  at  the  school  or  in  their  own  homes,  but  even  in  aiQjravated 
cases  much  can  !«  done  by  motor  training  to  improve  their  bodily 
habits  and  to  increase  their  range  of  usefulness,  making  them  more 
obaer\ant  and  appreciative  of  their  surroundings.  According  to 
Barr's  ex|)criencc,  the  best  results  are  obtained  from  military  drill, 
game.!,  and  gymnastics,  with  manual  training  varying  in  difficulty 
with  the  grade  of  l>ackwardncss,  the  relationship  of  the  grades 
in  mental  defectives  being  somewhat  like  the  successive  ages  in 
children  so  far  as  their  helplessness  is  aonccrncd.  The  lower  graclcs 
are  like  the  youngest  children,  but  their  phv  ical  conformation 
does  not  corresimnd  with  their  mental  barkwanmess. 

The  more  c<lucational  movements  should  l>e  directed,  first, 
to  the  [XMturc  and  gait  of  the  |)aticnts.  Their  most  characteristic 
defect  is  the  shambling  walk,  with  dragging  feet  and  slouching 
figure.  This  may  be  corrected  by  running  to  command  up  or 
down  hill,  by  walking  contests  on  tip-toe  indoors  or  out-of-doors. 

Such  exercises,  briskly  carried  out,  awaken  the  attention  and 
make  a  good  break  in  a  long  occupation  period. 

The  use  of  a  springboard,  supplementing  walking  drills, 
develops  elasticity  in  the  dragging  step.  Stooping  may  be  Ci>r- 
rected  by  balancing  a  lxx5k  or  basket  on  the  head,  and  the  poise 
and  ease  of  Ijcaring  thus  .improved.  The  placing  of  a  ladder 
horizontally  on  tiie  floor  is  a  valuable  way  of  correcting  a  slouching 
gait.  The  child  steps  between  the  round. ,  md  must  raise  the  foot 
well  at  every  step.  The  stepping  on  bricks  placed  at  regular  dis- 
tances is  another  device  for  the  same  purpose. 

Military  dri '  has  a  peculiar  educational  value  for  a  defective 
(Barr).  The  'oy  learns  a  certain  standard  of  precision,  at- 
tention, and  readiness  of  movement.  The  emulation  brought 
about  in  these  movements  is  important.  The  stimulation  '^f  his 
ambition  to  attain  to  the  power  of  the  others;  to  present  arms  in 
order  that  he  may  not  disturb  the  general  movement  of  the  squad, 
is  also  one  of  the  most  important  means  of  character  building. 


rHVSICAI.   EOICATION   OF   MENTAl  AND  IIO«AI.   I.KPKCTIVKS    115 

This  diKiplinc  i»  alM>  obtainwl  by  Kymnastic  exercises  in  which 
prompt  obedience  to  command  is  insisted  u|)on.  These  drills 
should  \x  pnaiKi\  only  for  a  few  minutes  at  a  time,  and  varie.1  in 
difficulty  to  suit  the  gru-le  of  the  class.  The  training  for  skill  and 
coordination  of  the  arms  and  hands  (FIk.  1,8)  iiuiy  l«  accom- 
plished by  the  horizonul  and  parallel  Urs  and  the  use  of  ladders 
for  climbing. 

One  of  the  most  defective  coordinations  in  the  atypical  child 
IS  found  in  the  power  of  Krasping.     The  weak  and  ncr»ous  finRcrs 


m 


of  the  untrained  imbecile  can  retain  nothing  within  its  grasp,  or 
tiie  nm-ous  clutch,  unconscious  of  its  violence,  is  •  ually  expressive 
of  mental  incapacity. 

It  is  necessary,  then,  to  train  this  coordination  by  simple  and 
strong  exercses  of  hanging  and  climbing,  catching  and  throwing, 
before  giving  to  the  child  a  hammer,  a  saw,  or  a  chisel  The 
throwing  and  catching  of  balls,  from  the  baseball  to  the  medicine 
ball,  are  useful,  as  are  the  simpler  exercises  on  the  bars  and  rings 

In  high-grade  defectives  this  power  of  regulating  the  grasp  is 
better  controlled,  but  it  may  be  still  further  trained  by  weaving 


'I 


2l6 


EXERCISE  DJ  EDUCATION  AND  MEDICINE 


club-swinging,  or  blackboard  drawing  with  both  hands,  after  the 
system  of  J.  Liberty  Tadd. 

Active  sports  are  to  be  warmly  encouraged,  the  exhilaration  to 
the  onlookers  as  well  as  to  the  participants  being  a  good  antidote 
to  the  lethargy  and  the  timidity  of  the  feeble-minded.  The  cir- 
culation is  stimulated  thereby,  and  the  muscles,  which  are  in- 
clined to  be  flabby  and  cold,  are  improved  in  nutrition. 

Dancing  is  an  amusement  in  which  most  of  these  children 
delight,  and  many  excel,  and  its  good  effect  is  evident  at  once. 
Running,   racing,   swimming,   leaping,   vaulting,   quoits,   tennis, 


Fig.  159. — Crippled 


nd   defective  cllildn-n   R.irdcniiiK   (PlayRrounds  Association   of 
PIliladtlNhia). 


croquet,  are  all  most  suitable,  while  football,  baseball,  and  basket- 
ball are  frequently  well  played  and  eagerly  discussed  by  children 
even  of  a  very  low  grade,  but  lack  of  initiative  is  the  outstanding 
characteristic  of  the  great  mass  of  incapables. 

During  a  recent  visit  to  an  institution  for  the  feeble-minded  a 
group  of  boys  were  seen  working  in  the  field.  Their  attention 
being  attracted,  they  all  stopped,  some  with  bent  back  about  to 
lift  a  shovelful  of  earth,  others  in  various  stages  of  arrested 
movement.  Thus  they  remained  until  called  back  to  their  work 
by  the  shout  of  the  foreman.     This  mental  apathy  expressed  by 


PHYSICAL   EDUCATION   OF   MENIAL    AND   MORAL   DEFECHVES     2l^ 

sluggish  physical  movement  is  present  in  nearly  all  low  grades  of 
mtelhgence,  and  can  only  be  reached  by  such  means  as  have  been 
described. 

The  other  type  of  mental  defectives  shows  an  abnormal  exci- 
tability, seen  in  restlessness,  insubordinatim,  and  truancy,  and  it 
IS  these  children  that  so  frequently  find  their  way  into  the  Juvenile 
Court,  the  reformatory,  and  the  jail. 

Blunted  intellect  and  moral  failure,  as  a  rule,  go  hand  in  hand, 
and  It  is  a  mistake  to  suppose  that  the  criminal  child  or  man  is 
naturally  bright.  If  apparently  bright,  it  is  usually  in  a  narrow 
line  and  self-repeating-more  allied  to  animal  cunning  than  to 
intellectual  power.  He  is  vacillating,  without  fixed  purjwse  or 
aim,  incapable  of  pursuing  a  consistent  plan,  and  of  a  rudimentary 
or  atypical  mental  development. 

Physical  training,  then,  is  specially  indicated  in  the  case  of  the 
youthful  delinquent  who  so  often  enters  the  school  for  delin- 
quents ix)orly  nourished,  anemic,  with  muscles  soft  and  flabby, 
frcm  a  life  passed  in  the  dark  and  unsanitary  tenement  house, 
homeless  on  the  street,  or  uncared  for  in  the  village,  .\long 
with  this  common  city  type  there  will  also  be  found  in  the  Juvenile 
Court  or  special  training  school  the  apathetic  dullard,  stupid 
and  shambling,  whose  every  motion  expresses  mental  lethargy 
and  iihysical  incapacity.  .As  a  rule,  these  cases  detest  exercise 
or  anything  that  disturbs  their  stupor,  and  for  them  discipline 
must  be  Spartan  in  character,  for  exercises  need  not  be  agreeable 
to  be  beneficial,  as  has  been  well  insisted  upon  by  Sargent  and 
is  daily  proved  in  the  reformatories. 

.A  course  of  physical  training  for  such  children  acts  beneficially 
in  three  ways:  By  awakening  the  brain  activity  of  those  who  are 
mentally  defective;  by  bettering  the  badiv  nourished  and  flabby 
muscular  system  by  developing  the  heart  and  lung  power;  and 
by  demanding  alert  and  p  ompt  response  to  command,  a  most 
important  lesson,  to  be  taught  so  well  in  no  other  way. 

The  course  of  training  for  the  incorrigible  youth  or  young 
criminal  would  begin  with  military  drill,  in  which  the  boys  are 
formed  into  companies  with  sub-officers  selected  from  their  own 


^ 


PHYSICAL   EDUCATION   OF   MENTAL   AND   MORAL   DEFECTIVES      219 

number.  These  companies  are  taught  the  usual  evolutions  of 
marchmg,  countermarching,  and  the  manual  of  arms  The 
authonty  of  the  officers  selected  from  among  the  boys  should  cease 
w,th  the  end  of  each  dr.ll,  and  promotions  should  be  made  with  the 
greatest  care.  There  is  always  a  temptation  to  bullv  if  the  giving 
of  th,s  temporary  authority  is  not  rigidly  guarded.  The  perfection 
to  which  the  military  drill  can  be  carried  is  shown  by  the  attain- 
ment of  the  boys  m  the  industrial  school  at  Glen  Mills,  whose 
evolutions  on  the  field  would  do  credit  to  regular  soldiers. 

The  second  means  of  training  is  by  gymnastic  exercises,  and 
those  in  use  at  Glen  Mills  are  semimilitary  and  founded  on  the 
German  plan  rather  than  the  Swedish.    The  boys  are  lined  up 
and  marched  to  the  gymnasium,  which   has  a  concrete  floor 
Coats,  hats  shoes,  and  stockings  are  removed,  and  a  brisk  drill 
IS  given  either  with  wands  or  dumb-bells.    This  is  followed  by  a 
five-mmute  period  of  free  play,  in  which  the  noise  of  the  boy,  is 
m  marked  contrast  to  the  comparative  silence  of  the  class  work. 
Following  this   IS  apparatus   work  on  the  parallels,  horse,  and 
horizontal  bar,  class  leaders  being  promoted  from  among  the 
boys.    After  another  .period  of  free  play  the  lesson  ends  by  gym- 
nastic games.    The  boys  are  then  lined  up,  shoes  and  stockingfare 
put  on,  and  they  are  marched  back  to  their  various  occupations. 
The  third  means  of  training  is  by  outdoor  sports  and  games, 
in  which  great  freedom  of  organization  and  conduct  is  allowed, 
although  strict  supervision  is  still  kept  and  the  boys  are  punished 
for  misbehavior  by  being  made  to  stand  along  the  side  line  of  the 
playground  with  the  back  to  it  for  periods  of  five  or  ten  minutes. 
If  the  offense  is  a  severe  one,  the  salutory  exercise  of  continuous, 
slow  deep  knee-bending  is  added  during  their  period  of  punish- 
ment.   Competitive  games  with  outside  institutions  are  arranged 
and  track  and  field  sports  are  freely  indulged  in,  giving  good 
opportunities  for  moral  and  ethical  training,  w^hich  are  not  ne- 
glected.   The  results  have  been  so  satisfactory  that  physical  train- 
ing is  now  established  on  an  equal  footing  with  industrial  training 
and   school  of  letters  work  in  the  regular  days'  curriculum  of 
these  incorrigible  boys. 


^11! 


220  EXERCISE   IN   EDUCATION  AND  MEDICINE 

Physical  training  has  a  marked  effect  on  the  physique,  mentahty, 
and  condu-t  of  criminals  who  have  attained  their  full  growth, 
as  proved  by  the  experiments  of  Hamilton  D.  Wey,  at  the  Elmira 
State  Penitentiary.  His  description  of  the  criminal  is  illuminating : 
"  The  average  youthful  criminal,  as  encountered  in  the  prisons 
of  the  Siate,  is  an  abnormal  production,  physically,  mentally,  and 
morally.  Generally  under  weight,  with  repulsive  features  in  some 
one  or  more  lines,  and  asymmetric  head;  he  is  coarse  in  fiber  and 
heavy  in  his  movements.  His  mind,  while  not  diseased,  is  unde- 
veloped, or  it  may  be  abnormally  developed  in  certain  directions, 
the  smartness  resulting  therefrom  partaking  of  low  cunning  and 
centering  about  self.  He  is  deficient  in  stability  and  will  power, 
and  incapable  of  prolonged  mental  effort  and  ;  lication.  His 
intellect  travels  in  a  rut  and  fails  him  in  an  emergency.  His 
moral  nature  shares  in  the  imperfections  of  his  physical  and  mental 
state.  Ho  does  not  possess  the  power  to  discriminate  betweer. 
right  and  wrong,  or  if  so,  it  is  in  favor  of  himself  and  avails  nothing 
to  society.  It  is  easier  for  him  to  incline  to  evil  rather  than  to  good, 
to  the  animal,  rather  than  to  the  intellectual,  and  in  this  he  is  true 
to  himself.  His  is  a  perverted  moral  nature— a  blunted  mind  and 
a  crude  body." 

It  is  to  physical  training  that  we  must  look  for  the  awakening 
of  those  powers  that  can  be  directed  by  firm  discipline  to  the  physi- 
cal, mental,  and  moral  betterment  of  these  derelicts. 

During  a  period  of  sixteen  months  a  class  of  43  dullards  was 
given  a  course  of  physical  training  at  Elmira.  This  comprised 
baths  at  frequent  intervals,  in  conjunction  with  passive  exercise, 
kneading  the  muscles,  working  the  joints,  and  general  friction  by  a 
professional  trainer;  and  a  manual  drill  in  calisthenics  to  supple- 
ment the  shop  work,  from  which  they  were  excused,  although  their 
school  work  was  taken  as  usual.  They  were  put  on  a  specially 
nourishing  diet.  The  physical  exercise  lasted  for  about  two  hours 
a  day.  They  began  with  the  ordinary  marching,  and  in  time  were 
taught  other  evolutions,  although  the  teaching  of  keeping  step  was 
a  matter  of  weeks.  When  they  could  do  this  well,  they  were  given 
setting-up  movements  and  exercises  with  dumb-bells  up  to  three 


PHYSICAL   EDUCATION   OF   MENTAL   AND    MORAL    DEFECTIVES      231 


pounds  in  weight.  The  first  experiment  lasted  from  June  until 
November,  and  showed  a  net  average  gain  of  i.2j  jiounds  a  man. 
Various  skin  diseases  disappeared,  the  muscular  condition  and  the 
carriage  improved,  and  the  response  to  command  became  much 
more  rapid  and  accurate.  The  whole  expression  of  the  face  im- 
proved, the  dull,  stolid  look  assumed  a  more  intelligent  expression, 
and  the  eye  gained  in  brightness  and  vivacity. 

.\  mental  awakening  accompanied  this,  and  their  progress 
in  school  rapidly  showed  the  effects.  During  the  five  months 
they  were  under  observation  their  average  marking  in  school  was 
74.16  ner  cent.,  as  against  45.2  per  cent,  for  five  months  immediately 
preceding  their  course  of  special  training. 

This  improvement  was  continued  to  a  remarkable  degree, 
and  the  stimulation  of  the  physical  powers  in  the  case  of  three  of 
the  class  impressed  their  mental  organization  to  a  degree  that 
it  enabled  them  to  earn  their  release  on  parole,  whereas  if  left 
to  themselves  their  minds  would  never  have  been  so  quickened. 

To  train  these  dullard's  legs  and  arms  to  act  with  precision  and 
in  unison  was  more  than  the  mere  rehearsal  of  mechanical  move- 
ments. It  was  menial  as  well  as  physical  training,  and  Dr.  Wey 
is  of  the  opinion  that  in  the  prisons  and  reformatories  of  the  country 
"  there  is  a  class  of  youthful  felons  who  can  thus  be  reached  in 
their  growth  period  and  improved  primarily  through  the  training 
of  the  body,  the  cultivation  of  the  head  follo^ving  in  good  time. 
If  penal  institutions  in  their  educational  work  could  more  often 
look  upon  bodily  training  as  a  powerful  agent  for  the  physical, 
mental,  and  moral  reformation  of  their  charges,  more  men  would 
be  released  at  the  expiration  of  their  time  competent  to  maintain 
themselves  honestly." 

This  result  is  only  to  be  obtained  by  careful  physical  training 
with  an  educational  purpose,  for.  as  F.  H.  Nibecker,  the  super- 
intendent of  Glen  Mills  School,  so  well  puts  it,  "  Hard  work  of 
any  particular  kind  is  not  complete  exercise,  nor  is  it  equiva- 
lent to  physical  training,  by  which  the  perception  is  quickened 
and  mental  training  results,  quite  as  pronounced  in  effect  as  from 
efforts  that  have  mental  training  more  directly  in  view." 


fl!i 


PART   II     ■ 

EXERCISE   IN   MEDICINE 

CHAPTER   XIV 

THE  APPUCATION  OF  EXERCISE  TO  PATHOLOGIC 
CONDITIONS 

The  efficacy  of  both  active  and  passive  exercises  in  the  treat- 
ment of  pathologic  conditions  depends  on  their  |)ower  to  change 
anatomic  structure  and  to  stimulate  physiologic  function.  This 
anatomic  and  physiologic  effect  is  very  differently  expressed  in 
exploits  of  endurance,  in  feats  of  strength  an<l  skill,  and  in  the 
passive  procedures  of  manipulation  and  massage. 

Kxcrcises  of  strength,  requiring  litUe  coordination,  rapidly 
add  to  the  bulk  of  the  muscle  tissue,  but  it  is  the  nervous  system 
that  receives  the  accurate  training  in  exercises  of  skill,  while  the 
muscle  girth  is  increased  but  slightly;  and  mild  automatic  exer- 
cises of  endurance  train  the  heart  and  expand  the  lungs  more 
surely  than  do  supreme  efforts  jf  .strength  or  the  cultivation  of 
skilful  muscular  control. 

Passive  exercise  has  an  almost  purely  mechanical  effect  on  the 
muscle  tissue  and  circulation  obtained  without  the  mental  cor'.en- 
tration  or  the  taxing  of  the  hear,  and  lungs,  required  to  :  jucate 
or  reeducate  atrophied  and  undeveloped  coordinations  and  to 
increase  the  powers  of  endurance,  and  so  must  be  consideretl 
somewhat  as  a  stimulant  by  which  the  nutrition  of  the  part  is 
maintained  or  improved  through  its  bloofl-supply. 

In  a  sprained  or  disab.ed  joint  the  circulation  is  subnormal 
and  the  process  of  repair  is  delayed  on  account  of  the  enforced 
immobility  of  a  structure  whose  natural  function  is  movement. 
Massage  is  the  most  valuable  means  of  hastening  recovery  in  such 
cases,  being  widely  employed  by  all  nations,  from  the  Turks  and 


APPUCATION    or   EXERCISE    TO   PATHOLOGIC   CONDITIONS      J33 

the  Africans  to  the  Siberians  and  the  Laplanders.     In  an  old  sprain 
the  tissues  are  matted  together;  the  surface  of  the  skin  is  dry  and 
harsh,  bluish,  livid,  and  shrunken  in  appearance.    The  stagnant 
blood  circulating  slowly  through  the  obstructed  and  narrowed 
vessels  is  unable  to  give  the  tissues  sufficient  nutrition  or  to  remove 
the  accumulated  debris  of  a  month's  inaction.    Manipulation  and 
massage  act  upon  the  muscles,  nerves,  blootl-vesscls,  and  skin,  and 
the  circulation  at  once  renews  its  power.     With  the  application  of 
friction  and  kneading  the  life  of  the  part  is  quickened,  the  veins 
and  absorbents  are  emptied  first,  and  the  fluid  contained  is  driven 
on  toward  the  heart;  the  pressure  falls  in  the  smaller  vessels  and 
tmy  irregular  lymph-spaces,  e;[tending  through  the  tissues  in  all 
directions.    Their  contents  are  driven  into  the  emptied  veins,  the 
circulation  becomes  more  rapid,  mctaliolisni  is  carried  on  with 
greater  energy,  the  tissues  become  full  and  sensitive  to  the  touch, 
and  the  parts  regain  the  even,  rounded  contour  of  active  health. 
The  skin  loses  its  harshness,  becoming  soft  and  pliable,  and  after 
a  single  application  the  muscles  are  capable  of  working  with  less 
fatigue,  while  the  joints  become  pliant  and  the  ligaments  relaxed. 
In  the  chapter  on  Massage  it  was  shown  that  a  muscle  ex- 
hausted by  lifting  a  heavy  weight  does  not  at  once  regain  its  power 
if  merely  allowed  to  rest.    If  it  be  treated  by  massage  for  the  same 
length  of  time,  its  strength  returns,  so  that  it  is  able  to  repeat  the 
effort  with  less  fatigue.     The  normal  irritability  of  the  muscle 
is  temporarily  restored,  as  shown  by  its  sensitiveness  to  electric 
stim.uli.     .\dhesions  are  permanently  stretched  or  broken  down, 
and  the  encumbering  waste  materials  thrown  into  the  circulation! 
while  the  effect  upon  the  nervous  system  is  indicated  by  the  dis- 
appearance of  the  pain  and  sense  of  insecurity. 

The  swelling  and  tension  so  characteristic  of  a  recent  sprain  can 
be  quickly  absorbed  by  gentle  and  careful  massage,  accompanied 
by  elastic  pressure  and  the  application  of  heat  between  the  treat- 
ments. The  tension  disappears  as  the  fluid  is  carried  off,  the 
temperature  falls,  and  the  pain  caused  by  pressure  on  the  sensory 
nerves  is  relieved.  Extravasated  blood  is  broken  up,  and  the 
adhesions  usually  found  between  torn  and  mangled  surfaces  are 
prevented,  although  time  is  always  needed  firmly  to  repair  struc- 


I 


ill! 


»4 


IXEICISE  IN  EDUCATION  AND  UEDICINE 


tures  that  have  been  actually  lacerated.  In  older  cases,  where  the 
synovial  membranes  have  lost  their  resiliency  from  long-continued 
distention,  where  the  tissues  are  sodden  and  edematous,  and  the 
efTusion  dense  and  firm,  massage  can  be  used  with  greater  freedom 
to  disperse  the  chronic  congestion  and  raise  the  tone  of  the  tissues. 
This  improvement  is  often  surprising  in  its  rapidity.  The  joint 
that  has  remained  for  weeks  cold  and  inactive,  incapable  of  per- 
forming its  proper  movements,  the  seat  of  constant  wearing  pain, 
recovers  its  flexibility,  loses  its  pain,  and  allows  itself  to  be  handled 
and  used  with  freedom.  Manipulating  the  joint,  moving  it  through- 
out the  greatest  extent  of  its  normal  range,  should  lie  added  to 
massage  in  recent  cases  as  well  as  those  of  long  standing.  Few 
minor  operations  give  such  instantaneous  and  striking  relief 
when  used  with  care  and  judgment.  These  movements  stretch 
or  snap  small  adhesions  that  limit  the  excursion  of  the  joint  or 
press  upon  nerve-endings,  causing  acute  pain. 

If  the  sprain  be  recent,  adhesions  are  prevented  altogether, 
but  if  they  have  already  formed,  they  may  thus  be  stretched  slowly 
and  gradually  by  repeated  gentle  movements  or  may  be  actually 
torn,  with  instantaneous  relief  to  the  patient.  It  is  in  these  ma- 
nipulations that  bone-setteis  have  arin'rcd  their  reputation  for 
supernatural  skill,  and  many  miraculous  j  tanccs  are  recorded 
of  the  immediate  recovery  of  long  disabled  joints.  After  [lerfect 
freedom  of  movement  has  been  obtained,  the  voluntary  power 
is  sometimes  slow  in  returning  and  the  reco'er;.'  must  be  com- 
pleted by  active  voluntary  exercise  in  accordance  with  the  natural 
movements  of  the  joint. 

A  muscle  that  is  repeatedly  exercised  in  movements  of  full 
contraction  against  resistance  gradually  pulls  its  origin  and  inser- 
tion nearer  by  its  inherent  elasticity,  even  when  at  rest.  It  is  this 
quality  of  muscular  tissue  that  gives  the  characteristic  semiflexed, 
pose  to  the  hand  and  arm  of  the  weight-lifter  or  oarsman.  It  is 
also  this  quality  that  is  of  assistance  in  the  treatment  of  the  many 
faults  of  posture  caused  by  the  overstretching  of  weakened  muscles 
and  ligaments,  and  the  consequent  overdevelopment  and  shortening 
of  their  antagonists. 

The  whole  struggle  of  man  is  to  establish  and  maintain  the 


APPUCATION   OP    EXERCISE   TO    PATHOLOGIC   CONDITIONS      325 

Upright  posture  by  the  constant  extension  of  the  Ixxly,  anil  to  ilo  this 
he  must  overcome  the  tendency  to  fleiion  caused  l)y  gravity  and  <k'- 
cupation,  for  the  entire  range  of  [mstural  rlefects,  such  as  llatfool, 
round  shoulders,  flat  chest,  irregular  development,  anil  fatigue  scoli- 
osis, are  essentially  occupation  disorders,  associated  with  the  mainte 
nance  of  tlie  erect  position,  first,  of  the  muscular  system;  second,  of 
the  ligaments;  and,  finally,  in  severe  cases,  of  the  bones  themselves. 
These  defects  are  causeil  most  frequently  l)y  long-continued 
faulty  positions  in  the  growing  child,  and  it  is  to  the  development 
of  the  weakened  and  overstrained  muscles,  to  the  stretching  of 
contractc<l  ligaments,  and  to  the  reeducation  of  proper  sitting  and 
standing  |)Ositions  that  we  must  look  for  the  greatest  curative 
effects  in  these  disorders. 

Exercises  of  strength  are  to  be  chosen  for  the  correction  of 
postural  faults,  and  their  selection  must  be  carefully  made,  for  the 
weakened  groups  must  be  isolated  for  action,  so  that  general 
fatigue  may  not  supervene  before  the  full  thera])eutic  effect  is 
obtained. 

In  certain  disorders  of  the  general  circulation,  with  symptoms 
of  heart  weakness,  like  breathlessncss  and  ledema,  complicate<l 
by  obesity,  typical  exercises  of  endurance,  such  as  walking  and 
hill-climbing,  have  been  used  with  success  by  Oertel  and  others 
in  Sweden,  Germany,  and  .America,  while  the  more  s|)ecialized 
exercises  of  strength,  in  the  form  of  simple  gymnastics,  duplicate 
resisted  movements,  and  the  passive  manipulations  of  massage, 
have  been  used  successfully  even  in  cases  showing  loss  of  com- 
pensation. 

The  treatment  of  obesity,  even  when  complicated  by  weakness 
of  the  circulatory  apparatus,  requires,  in  addition  to  the  regulation 
of  diet,  gymnastic  exercises  of  strength,  employing  the  great 
muscles  of  the  trunk  and  legs,  combined  with  exercises  of  endur- 
ance, such  as  walking  and  hill-climbing.  Massage  alone  does  not 
seem  to  have  much  effect  in  reducing  weight.  Von  Noorden  cites 
the  case  of  a  very  obese  subject  whose  arm  was  treated  by  vigorous 
massage  for  a  prolonged  period,  without  obtaining  any  reduction 
in  its  size.  The  value  of  massage,  however,  is  incontestable  in 
■s 


III 

i; ) 


( 


t*6 


XXEKCUE  IN  EOVCATION  AND  MEDICINE 


many  disorders  of  the  digestive  tract,  like  chronic  and  nervous 
gastritis  and  in  constipation,  where  it  can  be  applied  directly  over 
the  colon  throughout  its  entire  course.  Its  local  application  to 
rheumatic  joints  and  muscles  is  a  valuable  means  of  treatment  in 
certain  forms  of  torticollis,  lumliago,  and  low  forms  of  chronic 
arthritis,  but  most  general  disorders  of  nutrition,  like  gout  and 
diabetes,  require  exercises  of  endurance,  like  walking  and  riding, 
with  the  necessary  restrictions  to  prevent  overexertion. 

For  the  myriad  derangements  and  diseases  of  the  nervous 
system  exercise  in  some  of  its  many  forms  is  constantly  employed. 
In  paralysis  massage  preserves  the  nutrition  of  the  muscles  and 
prevents  contractures  by  kneading  and  stretching.  Percussion 
and  vibration  over  nerve-trunks  act  as  a  counterirritant,  and  even 
as  an  anesthetic  to  relieve  the  p  iin  of  neuralgia,  while  the  head- 
ache of  cerebral  congestion  may  frc<iuent!y  be  removed  by  strip- 
ping the  great  veins  of  the  neck. 

Exercises  of  skill  have  had  triumphant  demonstrations  in 
reeducating  the  impaired  coordination  of  tabetic  patients,  in 
correcting  the  incoherent  speech  of  the  stammerer,  and  in  quieting 
the  disordered  movements  of  the  unwilling  worshipers  of  St.  Vitus. 

The  tonic  effect  of  active  exercise  on  the  system  has  been 
referred  to  frequently  and  will  be  referred  to  again  from  time  to 
time,  but  there  is  one  condition  where  it  must  be  used  with  the 
greatest  caution. 

In  anemia  the  blood  is  so  <leticient  in  oxygen  and  in  red  corpuscles 
that  even  the  easier  activities  of  the  muscles  require  an  activity  of  the 
heart  out  of  proportion  to  the  effect.  This  increased  action  soon 
reaches  its  highest  possible  limit,  and  the  patient  has  to  sit  down, 
breathless  and  exhausted.  Because  of  this  difficulty  in  supplying  a 
sufficient  amount  of  oxygen  anemics  should  be  forbidden  all  exercise 
requiring  prolonged  or  severe  exertion,  and  the  tonicity  of  the 
blood  and  percentage  of  hemoglobin  must  be  increased  by  rest, 
overfeeding,  and  the  administration  of  iron  and  arsenic.  It  is 
only  in  the  form  of  massage  that  exercise  may  be  safely  applied,  and 
then  chiefly  to  prevent  the  evils  arising  from  overfeeding  and  rest 
in  bed. 


APPLICATION   OF    EXERCISE    TO    PATHOLOGIC   CONIlITIONll      21J 

The  increased  bloal-count  found  by  John  K.  Mitchell,  after 
mahsaxe  in  these  cases,'  is  proljably  to  lie  explaimil  cm  the  same 
Krounds  as  the  ex|)eriments  of  Hawke,  descril»<l  in  Chapter  II, 
as  looseninR  the  blood-cells  already  in  existence,  and  throwing 
them  into  the  circulation,  rather  than  as  an  actual  increase  in 
their  number. 

In  the  treatment  of  pulmonary  tuberculosis  the  place  of 
exercise  has  been  well  defined  by  KinKhorn,-'  who,  after  s|)eak- 
inx  of  the  oj^n-air  treatment  and  the  treatment  by  rest,  ailvises 
the  patient  to  Ijegin  with  walking,  at  first  on  level  ground,  for 
ten  or  fifteen  minutes,  every  second  day  for  several  weeks,  then 
every  day  for  several  weeks,  and  at  last  twice  a  day.  He  quotes 
the  rule  of  Brehmer:  "The  healthy  man  sits  down  Iwcausc 
he  is  tired;  the  consumpti\e  should  sit  down  so  as  not  to 
Iwcome  tired."  Patients  should  Yk  told  that  all  overexertion  is 
IKJison,  and  that  their  feclinss  should  Ijc  their  guides  at  all  times. 
The  acceleration  of  the  pulse,  |K.-rspiration,  palpitation,  rise  of 
temperature,  feelings  of  weakness,  discomfort,  and  hea<lache, 
are  all  signs  that  he  has  overstepped  his  limit. 

When  the  patient  stands  these  little  walks  without  harm;  when 
the  weight  increases  or  holds  its  own,  the  exercise  may  be  extended 
under  careful  super\ision,  but  mountain-climbing  shouUl  never 
be  jjermitted. 

In  cases  where  no  lesion  can  be  found,  but  where  the  tendency 
is  shown  by  the  history  of  exposure  to  infection,  by  family  history, 
or  by  the  formation  of  the  chest,  much  good  may  be  expected  from 
open-air  exercise,  accompanied  by  training  of  the  respiratory 
powers.  Deep  brcathhg  is  a  muscular  act  capable  of  education, 
and  the  capacity  of  the  lungs  or  mobility  of  the  thoracic  walls  can 
be  increasefl,  as  well  as  the  strength  of  any  other  part  of  the 
muscular  system,  while  the  general  circulation,  the  skin,  the 
appetite,  and  the  digestion  all  share  in  the  heightened  activity, 
and  healthful  sleep  is  insuretl  by  the  resultant  moderate  fatigue. 

Exercise  for  this  purpose  should  be  general  and  special.  Sing- 
ing and  elocution  lessons  are  valuable,  and  the  practice  on  a  wind 

'  .Solis  Cohen,  ■•  Physiolugic  Thera|ieutic3,"  vol.  vii.       >  "  Monlreal  Meci.  Jour," 


} 


3lH 


KXKiciiir.  IN  KmcATioN  AM)  UEniriNi: 


in^trumi'nl  has  l)ivn  ri'inmminiU'il.  Kut:n{nx  and  climl)inK  arc 
of  the  urculusl  value  ((ir  increasing  the  In.  ihinx  ca|>acit)'  if  kc|)t 
w  ithin  ihf  limits  of  fatiKuv.  All  I'li-rcists  nhoulil  Iw  prcscrilx'd 
In  wriilnK,  «ith  the  most  minute  dirc-ctions  as  to  time.  trei|uenc,v, 
anil  wverity.  an  '  a  record  of  the  iwlicnt's  »ei)(hl  shoulil  Ik' 
ke|>t,  ami  fre<|uent  examinations  ma>le  to  ilvlermine  his  proKrcss. 
a  loss  of  weiKht  iK'injf  follo.veil  li)  a  reduction  of  exercise. 

Daily  su|>erv  isi'il  exercises  arc  necessary  to  increa.se  rapidly  the 
|K)HTr  of  chest  expansion  and  '  italcaiwcity.  Theyshouldbcdirectcd 
toa  IraininK  in  the  iH'st  meth<Klsof  breathinn.  to  the  .stretching  and  de- 
veloping of  the  chest  and  alMlominal  walls,  and  should  be  preceiled  am  I 
followeil  by  accurate  measurements  and  spirometer  records.  They 
should  incluile  Ixith  active,  duplicate,  and  |)assivc  movements. 
but  It  must  be  rememlx'reil  that,  however  deep  the  respiratory 
movement  may  be,  the  amount  of  oxygen  absorl>e<l  is  only  in 
pro|H>rtion  to  the  need  of  the  Ixxly.  The  oxygen  in  the  blcxxl 
remains  measurably  constant,  ami  the  only  way  to  increase  its 
absorption  by  the  tissues  is  to  do  work  that  causes  the  breaking 
down  of  oxygen  comfiounds.  Deep  breathing  would  result 
naturally  from  more  demand,  but  it  woul<l  not  create  this  demand. 
Its  rAle  will  be  to  strengthen  the  Intrinsic  and  accessory  muscles 
of  respiration;  to  teach  the  coordination  necessary  for  deep  breath- 
ing, and  to  massage  tlie  alxlomii,„.  contents  by  w  ider  excursions 
of  the  diaphragm. 

Deep  breathing  alone  repeated  a  number  of  times  during  the 
day  is  useful,  and  its  practice  should  be  made  part  of  every  clay's 
r(?gime. 

The  normal  respiratory  act  is  a  com|»sitc  of  two  distinct 
types  of  breat'  ig— thoracic  and  abdominal.  The  thoracic  tyjie 
predominates  almost  to  the  suppression  5  the  other  among  all. 
irrespecti\e  of  sex.  who  wear  constricting  clothing  about  the 
waist-line,  and  the  first  care  must  be  to  reestablish  control  of  the 
diaphragm  and  alxlominal  walls.  The  following  exercises  should 
be  practised  before  a  mirror: 

Exenisr  /.—Patient  standing.  Place  the  hands  across  the 
abdomen.     Inhale  deeply.     Kxhale  by  pressing  on  tlie  abdominal 


APPLICATION    or   F.XF.RriHK    To    PATIIDLIKilr   rONDITIIINH 


"9 


wall,  kiTpiiiK  the  thorax  lixcl  in  the  |K>,iti„n  or  ins|>irati»n  iFig. 
161).     Ri|x.at  this  movctntnt  five  tlmi-»  slowly  with  the  thoracic 


Fir.  it>j.  —  Inhalalion  —  alidominal. 
Thr  abdomen  is  protruded  without  ex- 
{uindinK  the  thorax. 


Vig.  if>,t.— Rxhalation— ahdominaj. 
The  aUlomen  is  indrawn  and  the  breath 
expelletl  without  eonttacting  the  chest. 


wall  nxe<l,  usins  the  movement  of  the  aMominal  walls  only. 
Rest,  .^fter  a  little  practice  this  movement  should  be  done  with 
the  hands  at  the  sides. 


230 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


Hi; 


$• 


Exercise  II. — Patient  standing.  Place  llic  hands  across  the 
abdomen.  Inhale  forciljly  Ijy  pushing  out  the  alxlominal  walls, 
keeping  the  thoracic  wall  fixed  as  in  expiration.  Exhale  by  draw- 
ing in  the  abdomen. 

Repeat  five  times  slowly.  Rest.  .\s  soon  as  control  has  been 
obtained,  practise  this  exercise  with  the  hands  placed  behind  the 
back  (Figs.  162  and  163). 

Exercise  III. — Patient  stand- 
ing with  the  hands  across  the 


abdomen.  Inhale  forcibly,  using  the  thorax  only,  without  move- 
ment of  the  abdominal  wall.     Repeat  five  times  slowly  and  rest. 

As  soon  as  control  of  the  abdominal  walls  has  been  obtained, 
do  this  exercise  with  the  hands  behind  the  back  (Figs.  166  and  167). 

Thoracic  breathing  can  be  forced  still  further,  and  the  walls  of 
the  chest  stretched  by  using  the  arms  in  the  following  exercise ; 


1:     1^ 


APPLICATION    OF    KXERCISE    TO    PATIKJLOGIC    CONDITIONS 


231 


i 


Fig.  i(j6.— Thoradr  t.realhinK— inh;il;i-  Fiy.  i fi; .—Thoracic  breathing — exhala- 

lio".  lion.     The  girth  of  the  nixiomcn  rcm.iins 

uncliangctl. 

Exercise  /r.— I'alient  standing  with  the  arms  at  the  sides. 
Raise  both  arms  forward  (Fig.  164)  until  they  are  above  the  head. 


if' 


inhaling.  Hold  the  breath  and  stretch  upward.  Rise  on  tip-toes 
(Fig.  165).  Lower  the  arms  sideways,  ])ressing  backward  and 
exhaling  (Fig.  168).  Repeat  twenty  times  at  the  rate  of  about 
five  to  the  minute. 


a}3 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


Patients  will  sometimes  have  a  feeling  of  dizziness  and  may 
even  staKger  and  fall  at  the  sudden  change  of  the  blood-pressure 
in  the  head,  but  this  need  cause  no  alarm. 

Exirii.w  r.— Patient  standing  with  the  arms  at  the  sides. 
Raise  both  arms  sideways,  pressing  back  and  inhaling  (Fig.  169) 
until  they  are  above  the  head. 
Hold  the  breath  and  bend 
forward,  keeping  the  knees 
straight  until  the  hands  touch 
the   tloor    (Fig.    170).       Rise, 


Fifi.  i6q. 


Fig.  170. 


keeping  the  arms  above  the  head.  Lower  the  arms  sideways,  press- 
ing backward  and  exhaling. 

Repeat  twenty  times  at  the  rate  of  five  to  the  minute. 

This  exercise  compresses  the  air  in  the  lungs  and  forces  it  into 
the  cells  that  are  little  used  in  ordinary  breathing. 

The  following  duplicate  and  passive  movements  may  be 
employed  for  increasing  the  chest  mobility  and  improving  the 
respiration. 

Exercise  IV.— The  patient  lying  supine  on  a  plinth,  with  the 
feet  fixed,  the  arms  bent,  and  the  palms  up.  The  surgeon  grasps 
the  hand,  r)alm  to  palm  (Fig.  171),  and  pulls  upward,  to  full 
extension  of  the  arms,   the  patient  resisting   (Fig.  172).    The 


APPLICATION    OF    FXF.RCISK    TO    PATHOLOOK'   CONDITIONS       IJJ 

patient  then  jjulls  downwanl  and  forward  to  the  lirst  i)osition, 
the  surgeon  resisting. 


FiK.  i;i.-Artilidal  respiration.     Surgeon  |.ulli„i.  up  an,i  paiienl  re,i.,li„g 


FiR.  172.— .Stretcliing  of  llie  thorax  by  traction  on  tile  arms  i 
licia'  respiration. 


the  movement  of  arti- 


Inhale  as  the  arms  go  up  ano  exhale  as  they  come  down. 
Exercise  17/.— The  patient  h  !ng  supine  on  a  phnth,  the  lower 
part  of  the  thorax  supported  by  a  r.iller  four  inches  high,  the  arms 


h 


234 


EXERCISE    IN'    I.Dl'CATION    AND    MEDICINE 


behind  the  head,  and  the  chest  exi)andeil  in  inhalation.  The 
surgeon  presses  on  both  sides  of  the  lower  thorax,  directing  the 
patient  lo  exhale  (Kig.  173). 

Repeat  twenty  times  at  the  rate  of  alx>ut  ten  to  the  minute. 

.\  valuable  ^xercise  is  that  given  by  Zander's  machine,  known 
as  the  "tower,"  in  which  pressure  is  placed  on  the  back  by  a 


cushioned  pad  and  the  shoulders  are  drawn  upward  and  backward 
rhythmically  with  the  respiration.     (See  Fig.  38,  p.  67.) 

Butler,  of  Brooklyn,  has  reported  many  cases  of  incipient 
phthisis  in  which  deep  breathirg  lias  been  used  as  an  accessory  to 
overfeeding  and  rest,  wilh  marked  improvement  in  weight  and 
general  health;  but  if  the  tubercular  process  is  active  in  the  lung, 
deep  breathing  will  only  irritate  and  aggravate  what  nature 
attempts  to  splint  by  limiting  the  movement  over  the  affected  area, 
and  in  some  cases  a  hemorrhage  may  be  brought  on 

In  the  application  of  fixercise  every  attendant  condition  should  be 
made  as  favorable  as  possible  at  all  times,  to  get  the  best  therapeutic 
results.  Fresh  air  should  be  supplied  in  abundance,  and  treatment 
should  be  given  in  the  open  air  or  a  well-ventilated  room.  Many 
of  the  disorders  of  the  respiratory  tract  are  due  to  the  impurity, 
rather  than  to  the  temperature,  of  the  air  breathed.    Regularity 


APPLICATION    OF    KXERCISE    TO    PATHOLOGIC    CONDITIONS       235 


and  persistence  on  the  part  of  the  patient  are  absolutely  necessary, 
and  the  benefit  from  half  an  hour's  exercise  rejjeatcd  daily  is  incom- 
parably greater  and  surer  than  :in  equivalent  amount  taken  at 
long,  irregular  intervals.  The  necessity  of  constant  individual  su- 
])ervision  is  also  recognized  by  all  who  have  had  experience  in  the 
giving  of  treatment  by  exercise.  Eiery  movement  should  be 
pushed  to  its  utmost  limit  of  efficiency.  Many  reported  failures 
can  be  traced  to  the  lack  of  intelligent  personal  direction.  It  is 
not  sufficient  to  give  the  patient  a  vague  outline  of  a  course  and 
leave  its  carrying  out  entirely  to  an  assistant,  however  well  trained, 
for  in  no  department  of  medicine  does  the  personality  of  the 
surgeon  count  for  more.  His  presence  should  Ije  an  inspiration 
to  his  patient,  and  he  should  himself  insist  upon  accuracy  and 
precision  throughout  each  movement,  however  simple  it  may  seem 
to  the  casual  observer. 


lii 


CHAPTER    XV 

FLAT-FOOT  AND  ITS  TREATMENT 

Thk  advantage  of  the  upright  ,«sition  is  somewhat  oftset  by 
the  fre,,uenc7  of  <leformi,ies  due  to  a  yieWing  of  the  structures 
concer„e<l  w,th  support.  The  body  may  yield  at  the  spine,  which 
becomes  bent  and  distortcl;  at  the  l^nee-joints,  which  knock 
together  (genu  valgus);  or  at  the  arch  of  the  foot,  which  be- 
comes broken  down  and  flatten^,  causing  the  deformity  known 
as  ,.es  planus,  flat-foot,  everted  foot,  or  pronate<l  foot 

The  bony  structure  of  the  foot  is  arranged  in  the  form  of  two 
arches,  anteroiK,sterior   and  lateral.      The  antero,>osterior  arch 


Fr„.  .;..-A„,er„,«„eri„r„ch:  ,,  Shor,  „l.„,„  „„.™e„, ;  =,  1„„,  pl.„,»M,>™„, ; 
3,  plantar  fascia. 

(Fig.  174)  is  formed  by  the  os  calcis,  the  scaphoid,  the  three 
cuneiform  bones,  and  the  metatarsals,  with  the  astragalus  as  a 
keystone.  It  ,s  supported  by  the  ligaments  extending  between 
the  adjacent  bones  like  ties,  but  more  especially  by  the  short 
plantar  hgament  (Fig.  ,74,  ,)  binding  from  the  os  calcis  to  the 
navicular.    This  powerful  ligament  completes  the  socket  formed 

3a6 


FLAT-FOOT    ANP    ITS    TRKATMF.NT  337 

by  the  navicular  and  the  os  calcis,  into  which  tits  the  head  of  the 
astragalus,  or  keystone  of  the  arch.  The  other  main  ligament 
of  support  is  the  lonj;  plantar  (Fi^.  174.  2).  which  extemis  from 
the  bo<ly  of  the  os  calcis  to  the  proximal,  an.l  indirectly  to  the 
d.stal.  en.l  of  the  metatarsal  l;ones,  through  its  connection  with 
the  tendon-sheaths.  These  may  l,e  termed  the  r.rsi  line  of  <le- 
fense  m  preserving  the  antero|)osterior  arch. 

The  second  line  of  defense  consists  in  some  of  the  short  muscles 
ot  the  foot-the  flexor  hrevis  .ligitorum   (Fi,^,.  ,75,3,   and  the 


ih/,'*',  '"77!"  ""^'"'"'"  """'I"  "f  Fi„.  ,70.-S„„„d  by,r  „(  m„«cl™  „t 

the  tool:  I,  AWmlormnm   (liKlti-  J  al,-  tool-    ,    T,.™u.,     la     '  '  "'  """"t™  »> 

duclor  hallu™-     ,    n.,„n   I            j  '  '.  Imiioii  of  flexor  longus  haiiutis; 

°,„          ,,-    3,  fl«or   brcvis   dig.to-  ,,   fcndon  ot  peronem  longus-    ,     artej 

TRTchco        "™ '°"«"  ■■"""»  "'"'"■■  '■  '"•■"'•'  "< "" «--  io"«-  di^r 

'orum   and  lumbricalcs;   5.  flexor   brcvis 
minimi  digiti  (Richer). 

flexor  brevis  hallucis  (Fig.  ,„.  3)_assisted  by  the  tendons  of 
the  flexor  longus  hallucis  (Fig.  175.  4),  the  flexor  longus  ,ligi- 
torum  (Fig.  176,  4),  and  of  the  tibialis  ,x,sticus,  passing  around 
the  ,nner  malleolus,  and  binding  together  by  its  expanded  ten.lon 
all  the  bones  of  the  tarsus  except  the  astragalus.  The  tibialis 
antfcus  (Fig.  178,  i)  also  helps  by  lifting  the  proximal  end  of 
the  first  metatarsal  bone.  These  muscles,  by  their  action  all 
tend  to  hft  the  inner  side  of  the  foot  and  draw  together  the  limbs 
of  the  anteroposterior  arch,  like  the  string  of  a  bow 


If 


»38 


EXERCISK    IX    KDICATION    AND    MEDICINE 


The  lateral  arch  of  the  foot  (Fig.  179)  is  imperfe<.,  in  that  its 
sup|x)rt  IS  at  the  outer  side  only,  the  weiBht  being  borne  by  the 


Fig.  .;,.-D,.e,,l„>-,To/mu.,l<.,„f,ho  I  ig.  .;S.-Th..tcndonMhat»upix,r,  ihc 

0..1:  ■    Icr,„u.„,lo„„i,.;,,  i„u.,(„«.i;    ,.        arch:,,  Tibialis  amicus  p.„,i„„u„,l,r.„,. 

l.Mr  l,rcv„  hallucs;  4,  5.  adduc.or  hal-        nular    li„anH-nt  (,);   3,    soU-us;   4,   llcvor 

luc,  CR,ctar).  ,„„„„,  .|i„il,„um-  5,  til,iali,  ,K„icu.;  .. 

Ilcxor   toiiyus   hallucis;   7,  tendo  Achilles; 

S,  alKluctor  hallucis  (Richer). 

OS  calcis,  the  cuboid,  and  the  fifth  metatarsal.  The  arch  rises 
upward  and  inward,  and  its  free,  unsupported  edge  is  rcprescnteil 
by  the  astragalus,  the  navicular,  the  internal 
cuneiform,  and  the  first  metatarsal.  The 
lateral  arch  is  supported  principally  by  the 
tendon  of  the  peroneus  longus  (Figs.  177,  i; 
17ft,  2),  crossinf;  the  fof)t  diagonally  from 
the  cuboid  to  the  internal  cuneiform,  and  by 
the  ligaments  bintling  together  the  adjacent 
bones;  it  also  receives  some  sup|,ort  from  the 
tibialis  amicus. 

Tliu  body  weight  is  transmitted  through  the  tibia  to  the  astraga- 
lus. This  jiressure  on  the  keystone  tends  to  spread  the  members 
of  the  arch,  and,  in  so  doing,  to  stretch  the  long  and  short  plantar 
ligaments.  .■\s  the  structures  yield  the  inrier  side  of  the  foot  comes 
down,  and  the  lateral  arch  shares  in  the  flattening  process.    It  is. 


Fig.  r7g.— Lateral 
arch.  Pull  of  pero- 
neus longus. 


FlAT-r(XJT   AND   ITS    TREATMENT  jjg 

however,  the  unsup,»rte<l  part  of  the  arch  that  is  chiefly  alTccted 
and  the  flattened  instep  also  projects  inward,  causing  the  inner 
line  of  the  f(K,t  to  bulge  at  its  center,  ih.  iitline  becoming  convex 
mstea<l  of  straight  or  conca^■e.  Pressure  is  thus  put  on  surfaces 
of  the  Imne  that  are  not  accustomed  to  it,  and  scNere  cripplinj; 
pain  is  one  of  the  most  common  results,  while  corns  and  callosities 


FiB.  iSo.-Diri.c(io„  o(  ,he  holy  .-.iBht  Fie.  .Si.-Tran.fcrri„„  ll.o  dirccion  of 

on^ Jhe  u„s„„p„„ed  par,  of  ,h.  h.cral  ,hc  Kxly  .eifl,.  .o  ,h..  outer  ,ide,  ortu.l 

I»"«l   l«rl  of  the  arch,   ]iy  ralsina  the 
inner  side  of  the  shoe. 

add  their  discomfort  to  the  unnatural  pressure  and  friction  of 
the  abnormal  position. 

A  typical  case  of  flat-foot  would  then  show  a  lurning-out  of 
the  line  of  the  heel,  a  convexity  of  the  inner  contour  of  the  foot, 
and  a  concavity  of  its  outer  margin.  A  tracing  of  the  foot  would 
show  no  instc))  (Fig.  183).  While  this  deformity  is  sometimes 
caused  by  paralysis  of  the  posterior  tibial  groui)  of  muscles,  or  by 
the  peroneal  group,  and  is  also  the  result  of  traumatism  in  broad 


'Hi 


i 


340 


EXKRCISK    IN    EDICATIOS   AND   MEDICINE 


jumpers,  whose  arch  is  broken  ilown  hy  the  shock  of  landing  on 
hard  groumi,  still  the  great  majority  of  cases  are  what  might  be 

y  termed  static,  and  are  found  in 
nurses,  clerks,  waiters,  barlwrs, 
motormen,  and  all  others  whose 
long  hours  of  continual  standing 
keep  the  muscles  and  ligaments 
of  the  foot  constantly  u|)on  the 
strain.  It  is  also  frt^juently  found 
in  the  very  fat,  whose  excessive 
weight  is  too  much  for  their  liga- 


FJK.  iSa.— Fiat-toot  (Fowler). 


It  is  a  comparatively  fretjucnt 
condition,  and  is  usually  as.so- 
ciateil  with  other  deformities  of  the 
apparatus   concerned   in   supirart. 

Bernard  Roth,  in  his  series  of 
looo  cases  of  scoliosis,  found  it 
in  76  per  cent,  of  them.  In  an 
examination    of    1000    supposedly 


IL 


normal    students    I    have    found 
it    in    217    case.s.     Among    men 

applying  for  military  service  in  the  United  States,  about  3.4  per 

cent,  are  rejected  for  this  cause.    These  figures,  however,  do  not 

mclude  men  who  are  suffering  from 

flat-foot,  but  w!io  are  rejected  for 

some  major  trouble.    An  applicant 

suffering    from    hernia    and    flat- 
foot   would   be   rejected,  but    the 

cause   of   his   rejection    would   be 

given  as  hernia.     Lovett  has  founil 

many  cases  among  hospital  nurses, 

who   are   peculiarly  susceptible   to 

it. 

The  symptoms  are  very  var'ed  ^^ 

flat-foot  may  be  present  without  causing  much  irritation,  and 


Fig.  I8j.— Print  of  a  normal 
foot-sole  (A)  and  of  a  flat-foot  sole 
(bX  (Albert). 

A  considerable  degree  of 


H 


FLAT-FTOT   AND   ITS  ■HIEATJlrNT  J41 

again  Rrcat  |«in  may  l.c  cau*d  l.y  com|«.rativcly  sliKht  .leerfe. 
Painful  ,K.,ms  are  foun.l  a,  the  calcan«navicular  liKamcnt;  the- 
anterior  cml  of  the  os  calcis.  at  the 
attachitiem  of  the  short  plantar  liga- 
mqnt,  and  at  the  base  of  the  lirst 
metatarsal,  while  there  may  he  shoot- 
ing  pains   up   the   calf  of  the  leg. 
The  heels,  as  seen  from  the  back, 
are   characteristic,    the    line  of  the 
tendo  Achilles,  with  the  ball  of  the 
heel,  usually  making  a  sharp  turn 
outward    (Fig.    ,84).     This    is   em- 
phasized when  the  weight  is  borne 
on  the  foot.     It  may  very  often  be 
detected  by  examining  the  shoe  only, 
the    flat-foote<l    patient    tending    to 
wear   down    the   inner   side   of  the 
heel  and  sole. 

A  patient  should  be  examined 
with  the  foot  uncovered,  walking 
backward  and  forward  in  order 
that  the  foot  may  be  seen  in  action 
from  all  ,x,sitions.  The  inner  line  of  the  foot,  and  the  extent  to 
which  the  instep  is  destroyed,  should  be  noted. 

Cases  are  best  recorded  by  making  a  print  of  the  weight-bearing 
foot  as  follows:  Prepare  a  solution  of  perchlorid  of  iron  in  glycerin 
By  means  of  a  brush  or  cotton-wool  wrapped  on  a  small  stick 
imint  the  sole  of  the  foot  with  this  solution,  place  the  patient's  foot 
on  a  sheet  of  paper,  having  him  put  the  full  weight  down  upon 
It.  Brush  the  resulting  print  with  a  solution  of  tannic  acid,  and 
the  tracmg  becomes  black  and  legible,  and  forms  a  convenient 
means  of  following  the  progress  of  treatment. 

The  appearance  of  the  foot  is  not  the  only  thing  to  be  considered, 
for  the  arch  of  a  baby's  foot  has  an  appearance  of  flatness,  because 
the  pad  of  fat  which  occupies  the  arch  is  not  absorbed  until  the 
child  has  begun  to  walk. 


.  1.S4.  -Showing  onp  of  the 
lirst  sJKJis  at  flut-foot.  The  out- 
wuni  (Icflcclinn  of  the  lower  end  of 
the  tendo  .\ihilies  when  Height  is 
put  on  the  foot  (K,  11.  Oehsner). 


i 


343 


KXKKl'ISl;    I.N    HMCAIIIIN    ANU    MKDK'INK 


m  - 


Klal-ffM)!  i-,  liidili'  lo  In-  confust-d  with  ti.-n<)>yn()vitis,  tht-  pains 
frtim  inrn-'  and  rall()siiif>,  am!  with  n(.'urai^;iu  (tf  the  nu'tatarsiis  or 
thi'  li-nil(>  .Uhilks.  Thf  mn>\  frnnu-nt  mistake  in  diagnosis  is 
rhi'iimalism,  which  seldom  alTirts  the  fo<)i  alone,  allhoui^h  I  have 
seen  it  in  one  case  in  which  the  dia;;nosis  of  rheumatism  was 
lont'irmed  Iiy  its  ^uhsequent  apjiearanee  in  other  joints. 

Ahhou;ih  not  a  fatal  disease,  it  is  the  anise  of  threat  pain  and 
discomfort,  and  sometimes  the  patient  becomes  chair  or  hedridden. 

'I'reatment  must  lM)th  supjHiri  tlie  arch  and  correct  tlie  de- 
formity. M)  thai  no  treatment  is  complete  which  does  not  develop 
the  structures  in\olved  in  the  iiornial  preservation  of  the  arch. 

'I'he  market  is  llcxKled  with  patent  devices  for  the  support  of 
the  hn»ken  down  arch,  liut  no  meciianjcal  tn^atmenl  should  lie 
eniplo.eri  unless  it  accurately  lits  the  particular  case.  More  harm 
than  j;(M)d  has  l-een  done  hy  the  use  of  ill  fitting  and  imperfectly 
H'tj'portini^  f(H)l-plates.  A  fiH it  plate  or  handa^^e  of  any  kind 
must  he  l(M)ked  u|»on  in  tin  iij^ht  of  a  s|ilint,  l()  he  discontinued  as 
MKm  as  ]K)sv.il)le,  and  lo  he  used  only  in  conjunction  with  other 
means  of  treatment. 

In  most  cases  treatment  hy  exercise  shouhl  he  ))ejiun  liy  ma- 
nijiulation,  stretching,  and  massa^jinj;  the  f(K)t;  hut  where  the 
pain  is  t(K)  se\ere.  it  may  I>e  necessary  to  j;i\e  the  foot  a  complete 
rest  for  two  weeks  or  more  hy  incasing  it  in  a  plaster  bandage. 
When  tenderness  is  sulVicienlly  lessened,  the  following  manipula- 
tions and  active  exercises  may  he  starte<l: 

lixi-nisf  I.  -I'atient  .sitting,'.  Ic.l,'  extended  and  sujiported  just 
aliove  tlie  ankle.  (Irasp  the  rl^ht  foot  just  atiove  the  ankle  with 
the  left  hand.  Place  the  ri^hl  hand  on  the  sole  of  the  fiH)t.  With 
the  thumb  jiointin^  toward  the  toes  j^rasp  the  fi«>t  firmly,  circum- 
duct the  foot  slowly  in  the  folhiuin;;  order:  ir)  Extension;  13) 
inversion;  i,^t  llexion;  (4)  eversion. 

'!  his  should  be  done  with  as  much  force  as  can  be  used  without 
pro<lucinj^  jiain.  and  repeated  up  lo  about  thirty  times.  Kach 
part  of  the  movement  should  be  sejjarated  from  the  next  by  a 
distinct  jiause.  When  this  has  been  learned,  it  may  be  replaced 
))V  the  acti\e  movement. 


rwr-riMir  wn  iis  ikKArjiKNi 


■  '"^r— '"Irxiciii  i.f  th,-  f,„,t. 


Exmi.sr  II.     F( 


,,  ,         '■'"'"  '"  "i'=  «'"«-•  position.     Circumcli.ciion  in 

the  same  onler  ,v,tl,„ut  assistance.     Repeat  lifty  times. 


244 


EXERCISE  IN   EIJUCATION   AND  MEDICINE 


The  operator  should  super\isc  this  movement  an;l  encourage 
the  patient  to  make  the  extension  and  inversion  as  complete  as 


, — Eversion  of  the  foot. 


possible,  so  that  the  long  and  short  flexors  and  tibial  muscles  may 
have  complete  contractions  at  each  movement  (Figs.  185-188). 


FiB.  i»0. 

Exercise  ///.— I'atient  standing  with  toes  in  and  heels  out, 
and  about  twelve  inches  apart  (Fig.  189).  Rise  on  the  toes  and 
press  out  slowl;-  (Fig.  190).    Repeat  fifty  times. 


FLAT-FOOT   AND    ITS    TREATMENT 


245 


Exeriise  IV. — I'aticnt  standing,  feet  parallel  and  six  inches 
apart.  Raise  the  inner  side  of  the  foot,  throwing  the  weight  on 
the  outer  border.     Repeat  fifty  times. 

This  transfers  the  weight  from  the  ligamentous  supjwrt  to 
the  bony  ridge  of  the  outer  edge  of  the  fixjt  (see  Figs.  180  and  181) 
and  should  be  followed  by — 

Exertise  V. — Patient  standing,  feet 
parallel,  weight  resting  on  the  outer  side 
of  the  foot  (Fig.  191).  Walk  forward  and 
backward  fifty  steps,  keeping  the  feet 
parallel. 

This  exercise  is  also  valuable  in  throw- 
ing the  weight  of  the  body  on  the  solid 
part  of  the  lateral  arch,  and  is  one  that  is 
often  instinctively  taken  by  patients  to  re- 
lieve the  intolerable  pain  caused  by  the 
overstretching  of  the  ligaments. 

Exercise  VI. — Raise  the  heel  one  inch 
from  the  ground  and  walk  without  bring- 
ing the  heel  down  at  all,  as  if  the  heel 
were  painful. 

This  exercise  may  be  practised  indefi- 
nitely, the  patient  walking  for  100  yards 
without  letting  down  the  right  heel,  and  then  the  next  100  yards 
without  letting  down  the  left,  or  raising  the  heels  when  crossing 
the  street,  or  other  plans  that  will  readily  suggest  themselves. 
A  little  practice  will  enable  him  to  walk  in  this  way  without  limp- 
ing or  otherwise  attracting  attention. 

The.sc  exercises  should  be  repeated  daily,  and  in  slight  cases 
should  be  carried  on  for  at  least  three  months,  whereas  in  severe 
cases  it  should  be  kept  up  as  a  daily  routine  for  at  least  one  year. 
In  favorable  cases  this  may  be  all  that  is  required  (Figs.  192-195), 
but  usually  it  will  have  to  be  combined  with  some  form  of 
specially  designed  shoe,  with  strapping  or  other  mechanical  sup- 
port to  retain  the  gain  and  to  prevent  the  original  cause  of  the 
deformity  from  undoing  the  corrective  work  of  the  exercises. 


I'iK,  i(>i.— Walking  I 
outiT  sides  of  IlK-  f 


i'5 


:;il 


'ili  ii 


346 


KXFRCISE   IN   EDUCATION   ANn   MEDICINE 


The  shoe  should  present  a  slrai^ht  inner  line,  allowing  perfect 
freedom  to  the  toes,   and   hij,'h   heels  should  be  avoided.     An 


I-'iK-  193. — M.  April  ,1.     AfUT 


excellent  shoe  has  heen  devised  by  Small,  of  Boston,  in  which  the 
ri^id  shank  from  the  heel  to  the  sole  of  the  shoe  is  replaced  by  one 
that  is  flcxil)le.  allowing  free  movement  to  the  whole  ftxrt  and  vet 


FIAT-POOT    AND    ITS    TKEATMKXT 


247 


giving  adequate  support.     The  inner  side  of  the  heel  and  sole  may 
be  thicliened,  or  a  cork  insole  may  be  made  to  lift  the  inner  side 


Fi«. 


<IA.  —A.  M.   XovcmU-r  4.    I{cr„rT 
Ijeginning  Ireatmcnt. 


I'll!.    K15.— A.    \l.     March   10.     Atlei 
fxercist?  iroatmont  for  tivt  montlis. 


Of  the  foot.  This  places  the  thrust  of  the  botlv  weight  outward 
toward  the  supported  side  of  the  foot-arch,  and  lessens  the  strain 
on  the  ligaments. 


Fig.  .,f,.-VVhi,n,an',  pl.„e  ,0  ™pp„rl  Ih,-  arrh  of  ,hr  too,  i„  ,la,.fo„,  (Fowler), 


.Among  the  many  plates  designed  for  the  foot,  undoubtedly 
the  best  ,s  the  one  described  by  Royal  ^\hitraan  (Fig.  196).     A 


348 


EXEKCISE  IN   EDUCATION   AND  HEDKWE 


plaster  cast  of  the  foot  is  taken,  and  an  iron  plate  is  fitted  to  it, 
with  bearing  |X)ints  at  the  head  of  the  first  metatarsal,  under  the 
heel,  and  behind  the  fifth  metatarsal  bone.  From  these  bearing 
points  the  plate  fits  into  the  arch  of  the  instep,  and  may  be  trimmed 
to  suit  the  convenience  of  the  wearer.  It  is  easily  removable  from 
the  shoe,  and  does  not  press  upon  the  foot  except  when  it  is  bearing 
the  body  weight. 

.\  bandage  which  has  proved  exceedingly  useful  in  the  hands 
of  Ochsner  is  described  by  him  as  follows: 

"I  first  select  a  good  make  of  zinc  oxid  adhesive  plaster  in 
12-inch  rolls  .\fter  measuring  the  patient's  leg  I  mark  off  the 
adhesive  strips  according  to  the  size  of  the  extremity.  For  the 
purpose  of  strapping  a  male  patient  of  brdiiury  size  I  mark  off 


Jl^xl) 

jiffxtf 

Hi  I      z 

iihrr 

*r/ 

Fig.  197. — Showing  how  the  zinc  oxid  plaster  is  marlced  off  preparatory  to  cutting  strips 
for  strapping  an  adult  male  pati. '  'a  foot  (E.  H.  Ochsnei). 

7  strips  }  inch  wide  by  32  inches  long,  with  a  cross  line  at  its 
middle;  16  strips  J  inch  wide  and  18  inches  long;  i  piece  t,\  inches 
by  13  inches;  i  piece  t\  inches  by  I3  inches;  i  piece  3^  by  11;  and 
4  pieces  3i  inches  by  8  (Fig.  197).  I  do  this  as  a  matter  of 
convenience,  and  in  onlcr  to  prevent  the  unnecessary  handling  of 
adhesive  plaster  after  the  facing  is  once  removed. 

The  heel  of  the  patient's  ftmt  is  now  placed  on  the  chair,  with 
the  knee  flexetl,  and  a  short,  hard,  roller  bandage  is  looped  around 
the  foot.  I  direct  the  patient  to  draw  the  foot  upward,  thus  placing 
the  foot  at  a  little  less  than  a  right  angle  to  the  leg,  moderately 
inverted  and  adducted,  the  patient  holding  the  bandage  himself. 

I  now  put  the  middle  of  the  32  x  i  inch  strip  over  the  bottom  of 
the  heel,  about  one  inch  from  its  posterior  border,  one  half  up  the 


FlAT-rnoT   AND   ITS   TREATMENT  349 

outer  surface  of  the  leg,  without  tension,  and  the  other  up  the 
inner  surface  of  the  leg,  as  tight  as  I  can.    I  then  place  one  of  the 
shorter  narrow  strips  on  the  inner  surface  of  the  foot,  parallel  with 
the  sole,  and  on  the  outer  surface.     The  remaining  narrow  strips 
are  placed  iii  the  same  manner, 
each  one  slightly  overlapping  its 
predecessor.     When  these  are  all 
in  place,  I  cover  them  with   the 
7  remaining  strips,  beginning  at 
the  upper  part  of  the  leg,  as  illus- 
trated in  Fig.  198.     These  strips 
will  remain  in  place  and  be  ef- 
fective from  four  to  eight  weeks, 
when  they  may  be  removed  with 
benzin.  The  foot  is  washed  with 
soap  and  warm  water,  carefully 
dried,  and  it  is  again  restrapped 
the  following  day.    A  foot  may 
require  from  two  to  ten  strappings,     ,  Jt;':hlt':v.,°™T™„1 
and  the  relief  is  almost  immedi-     ""i"  (E-  H.  Orhsncr). 
ate.    This  strap,  ^ng  tends  to  supinate  the  foot  and  relieve  the 
pam  by  relaxing  »he  muscles  and  supporting  the  ligaments." 

I  have  quoted  this  at  length,  because  the  best  results  can  be 
obtamed  by  a  combination  of  this  treatment  with  exercise.  From 
the  perishable  character  of  the  plaster,  one  is  less  apt  to  depend 
upon  it  alone,  as  is  so  frequently  done  with  the  metal  flat  foot 
supports,  while  the  danger  of  injury  to  the  foot  from  bruising  and 
formation  of  callosities  arising  from  the  use  of  plates  unskilfully 
applied  is  completely  avoided. 

A  flat-foot  plate  or  bandage  must,  as  already  emphasized,  be 
regarded  in  the  same  light  as  a  crutch  or  cane  would  be  for  a 
joint  unable  to  bear  the  strain  of  use,  and  it  is  to  be  discarded 
when  the  normal  strength  has  returned  and  undue  irritability  has 
disappeared. 

To  continue  the  support  after  the  indications  for  its  use  have 
disappeared  is  to  hamper  the  normal  functioning  of  the  muscles 
and  ligaments  of  the  foot  and  leg. 


CHAPTER   XVI 

THE  CAUSE  AND  TREATMENT  OF  ROUND  BACK, 
STOOPED,  AND  UNEVEN  SHOULDERS 

If  an  infant  be  placed  upon  its  back,  it  will  lie  with  a  straight 
spine  and  thighs  flexed  to  nearly  90  degrees.  If  it  be  placed  in  a 
sitting  posture,  the  thighs  remain  flexed,  but  the  spine  shows  a 
single  convex  backward  curve,  involving  its  entire  length,  but 
with  the  assumption  of  the  standing  posture,  the  right  angle  be- 
tween the  trunk  and  thighs  must  be  extendetl  to  a  straight  line, 
and  this  is  effected  by  a  compromise  between  the  lumbar  spine 
and  the  hip-joint,  both  yielding  part  of  the  way. 

When  the  hip-joint  is  extended,  the  iliopsoas  muscle  is 
stretched,  though  this  extension  is  not  sufficient  to  preserve  the 
straight  spine  of  the  sitting  posture.  \  sharp,  forward  cur\e  de- 
velops in  the  lumbar  region.  The  anterior  vertebral  ligaments 
are  stretched,  the  intervertebral  discs  thicken  anteriorly,  and  the 
erector  spina;  muscle  becomes  active  and  ])Owerful.  This  curve, 
which  is  very  marked  in  young  children,  gives  them  their  char- 
acteristic "pot-bellied"  appearance,  and  is  accompanied  by  a 
localization  of  the  compensating  backward  curve  to  the  dorsal 
region,  and  by  the  formation  of  a  third  in  the  cervical  region, 
showing  the  same  forward  convexity  as  the  lumbar  cur\e.  These 
three  curves  are  ])hysiologic,  and  are  always  found  in  the  adult 
normal  spine,  and  it  is  their  exaggeration  or  imperfect  develop- 
ment that  will  be  considered  in  this  chapter. 

The  shoulder-girdle  is  constructed  to  i)ermit  the  widest  range 
of  movement  with  the  utmost  lightness  of  structure,  but  the 
pelvic  girdle,  whose  chief  office  is  that  of  support,  is  firm  and 
arch-like,  with  powerful  ligaments,  heavy  bones,  and  scarcely 
perceptible  movement,  while  the  entire  weight  of  the  head,  neck, 
350 


X.EATMENT   OP   .OWD   BACK    AND   STOOPED   SHOULDERS      .Jx 

K"!^'.':'  f  °f  """-^^  "Pon  the  flexible  ana  grow- 

mches  away  from  the  plane  of  the  upriehT'  AnJ      .'r'''™^^'"^ 

behind  t.     To  obtain  th,  m.  .  "  '"'^'"'''  '^ 

marked  with  a  th  pencil     '^rxr'". '^  f°"°"'"«  >"■■"'»  "« 
head  of  the  fibula     rT.h.  f'       u™"'  ""'""''"'';  <^'  'h« 

lumbar  soine-    cl  th  t  T"  '^"^hanter;    (4)    ,he   fourth 

iuraoar  spine,  (5)  the  seventh  dorsal  soine-  m  ti,»      •        ,    , 
vertebm  prominens;  and  (7)  the  r^ddk  of'th  *??'  °'  ""^ 

These  points  having  been  Ck  J    hi      ,        "'"°"'  P'""'^- 


f. ' ' 


11 


35a 


EXERCISE  IS   EUtlCATION   AND  UEDICINE 


hcif;ht  <>{  each  of  tht'sc  |x>ints  is  thvn  nntol,  ami  from  this  data  the 
imsturu  can  be  graphically  shown. 

A  com|)Ositc  of  72  normal  l)oys  (Greenwood)  between  the  a^es 
of  fifteen  and  nineteen  years  shows  the  following  tracing  (Fig.  200). 


♦?» 


FiH-  iw  -Lovctl'i  aiipiiralun  fi»r 
mea.<iiirinK  %ariatioti«  from  normal  alii- 
tudf  ill  llie  anteroiKMieriur  plum-. 


Fin-  300. — Com- 
{Misitc  rurvi-  of 
si-vcnty-two  nor- 
mal lK>yH  (<in.'cn- 
wockI), 


Vig.  301.— Curve  of 
young  atlult  ft>malf  of 
((oo(|  larriagi'  (I.uvett). 


By  means  of  this  stantlanl  \vc  are  enabled  to  divide  faulty 
attitudes  into — (i)  Round  back,  showing  a  general  cun'c  back- 
ward, with  little  lordosis.  (2)  Round  hollow  back,  with  the 
backward  projection  greatest  in  the  middorsal  region,  and  with 
pronounced  lordosis,  the  forward  projection  of  the  head  bringing 


TREATMENT   OF    R'JfXI)    BACK    AND    STOOPEO   SIIOI'LDERS      3^3 

the  upiwr  three  measurements  almost  in  line.  (;)  Forward 
displaeement  of  the  shoulders,  the  scapuU'  and  clavieles  l>einK 
displaced  mdeiwndently  of  the  condition  of  the  spine.  This 
condition  may  e.\ist  either  with  or  without  a  rounded  hack 
A   graphic   tracing  of   these  curves   may   also   l,e  obtaine.1    by 

the  pantograph  mcthixl  de- 
scribed in  the  following 
chapter. 

From  the  stand|>oint  of 
treatment  these  deformities 
may  be  classihed  into  flexi- 
ble and  resistant. 


FiR.  jo,.-MakinB  ,,  trad.,B  of  Ihc  a„,o„,-  Fin.   =o.,. -Anlcro|x„,crior    trac- 

^.^j  ,  „„.»  „I  ,h,.  .„i,„.  ,,,  ,h..  ,a„.„„,a„h        i,«,  of  ,h..  ,„i„ c„r„,  ■  ,x»,u°e; 

b,  lirsl  lyiic  of  muiiil  lark  ;  f,  cx- 
Innic  misfanl  round  liaik  in  a 
vounR  nirl- 

During  the  years  of  growth  posture  will  usually  take  care  of 
Itself  if  constant  change  be  allowed,  for  change  is  instinctive  and 
automatic  in  the  chil.l,  and  his  varied  activities  may  be  truste<l 
to  lead  him  along  normal  lines.  If.  from  inherent  weakness  or 
the  con6nement  of  school  life  without'  the  relief  of  games  and 


y 


»54 


KXKRCISK   IN    KniCATlON   ANU  UEUICLVE 


IjWiftijI 


play,  this  normal  development  Ik  hindered,  the  spine  is  one  of  the 
first  |>arts  of  the  anatomy  to  reveal  it. 

The  causes  of  round  sh,>ulders  are,  then,  those  general  con- 
ditions that  produce  muscular  or  constitutional  weakness,  like  rapid 
growth,  overwork,  Iw.l  air  in  sch<K)ls  or  home,  acute  illness,  myopia 
uncorrectwl  l)y  glasse^s,  iKK>r  hyf-ienc  at  home,  or  general  lack  of 
exercise,  and,  si-condly,  occupations  that  <leman(l  long-continued 
flexion  .luring  the  period  of  growth,     .\mong  these  may  l,e  men- 
tione.l  the  use  of  ill-fitting  sch<K>l  furniture,  long-continued  writing 
an<l  drafting  or  work  with  the  microscope;  in  fact,  the  requirement 
of  any  lixe<l  i>osition  for  more  than  a  few  minutes  at  a  lime  in  a 
young  child.     His  restlessness  In   school,  is   his  only  means  of 
protest,  and  is  the  ol,ject  of  much  misapplied  correction  by  those 
school-teachers    who   believe    that    quietness   ami   goo<lness   are 
synonymous.     The  third  cause,  more  direct  than  either  of  the 
others,  is  the  wearing  of  clothing  sup|)ortcd  by  susfwnders  bear- 
ing on  the  [mints  of  the  shoul.lers,  tending  to  pull  them  downward 
and  forwanl  or  even  to  produce  a  painful  deformity  of  the  scapula. 
.\n  examination  of  the  back  should  begin  by  testing  the  spine's 
range  of  movement,  forward,  backward,  and  lateral.     The  i)atient 
should  then  take  his  habitual  standing  position,  which  he  should 
retain    until    his    self-consciousness    abates.     The    overcorrected 
stamling  postuVe  should  then  be  tried.    This  may  be  .lone  by 
having  him  force  the  chest  forwanl  an.l  upward  to  touch  the 
surgeon's  han.l,  hel.l  just  far  enough  in  front  of  and  parallel  to 
the  chest-wall  to  Ijring  the  contour  of  the  thorax  directly  above 
that  of  the  ab.lomen.      This  maneuver  should  always  be  .lone 
before  a  mirror,  that  the  patient  may  associate  the  sensation  with 
the  picture  of  the  correct   ijosture,  an.l   it  will  take  time  and 
patience  on  the  part  of  l,oth.     He  should  then  be  taught  to  take 
several  long  breaths  without  relaxing  the  jHwe.    If  the  chil.l  be 
place.l  face  downward,  with  the  arms  at  right  angles  to  the  l)o.ly 
flexibility  of  the  shoulders  can  be  tested  by  attempting  to  force 
them  back  of  the  middle  line  of  the  Ixxly.     They  should  then  be 
lifted  upwar.l   besi.le  the  head   an.l   forced  backward.     During 
these  movements  the  whole  spine  should  be  narrowly  observed, 


by  hollo«i„K  the.  lolcr  ,«.„  of  .111  ""'^'  ''"  '"'""''"'•"' 

mhy,R.rcxtcnsi„nof  thofll)ows  "K-'mmis,  asshovvn 

and  kni'i-s,  as  will  as  of  the 
spinal   liKamcnts,  an<l    if    the 
patient  tan  voluntarily  assume 
a    correct    [wsiiion,   the  case 
may  lie  pronounce.!  non-resist- 
ant.    In  resistant  round  shoul- 
ders   and    forward    displace- 
ment,   however,    there    is    al- 
ways more  or  less  structural 
change,   involving   a    for^vard 
curvature  of  the  upper  part  of 
the  scapula,  a  shortening   of 
'he  coraco-acromial  ligament, 
or,  according  to  Fitz,  a  tight- 
ness of   the  serratus    magniis 
muscles,  associated  with  weak- 
ness  of   the   rhomboids   and 
tra|>ezius. 

It  is  a  very  fretjuent  de- 
formity among  school-children, 
and  it  occurs  in  almost  20  per 
cent,  of  university  students 
uncomplicated  with  other  |k)s- 
tural  defects.     Where  a  greater 

deviation  is  present,  such  as  lateral  curvature,  a  note  is  usualiv 
ma<k  of  the  scol,os,s  only,  .so  that  its  occurrence  is  more  frJ- 
quent  than  these  figures  would  indicate 

It  is  frcjuently  discovered  in  girls  about  the  age  of  puberty 
«hen  especal  attention  is  apt  to  be  paid  to  their  figure  and  ca": 
nage. 


Fig.  ao4.— Showing  a  common  undcr- 
wa«l  wilh  the  strap,  l^aring  ur»n  the 
oulvr  |»,rl  or  movable  i«,rt  of  the  shoulders 
(Goldthwait). 


m 


If 


a56  XXEICISE  IN  EDUCATION  AND  MEDICINE 

Round  shoulders  arc  not  likely  to  l>c  outgrown,  and  patients 
usually  Ijccome  iwrmancntly  and  structurally  set  in  the  faulty 
ixisition,  with  flattcnctl  chest-walls  and  distorted  finure. 

By  adc<|uate  treatment  all  cases  are  capable  of  improvement, 
and  almost  all,  except  the  most  resistant,  are  ca|)ablc  of  complete 
cure.  Before  lK-ginnin(!  treatment  ii  is  {m|K)rtant  to  differentiate 
between  the  flexil>lc  and  the  resisUint  rases  and  lietween  Ijoth  ami 
arthritis,  where  pain  is  usually  a  prominent  symptom.  An  irri- 
tated spine  must  also  be  excluded,  as  well  as  the  early  stage  of 


Fig.  aoj.— Comet  support  of  dothing.    The  Wright  romM  on  the  root  of  the  neclt 
insIr.-Ki  of  the  shoulder  lil>s  (Goldthwait). 

Pott's  disease,  so  that  any  case  of  sore  spine  before  being  treated 
by  exercise  should  undergo  a  rigid  examination,  and  \k  kept  for 
some  time  under  careful  observation. 

Treatment  may  be  divided  into— fi)  Hygienic;  (2)  exercise; 
(3)  stretching. 

(i)  Hygienu.—The  patient  should  have  the  best  available 
surroundings  as  to  light,  air,  and  food,  because,  as  a  rule,  they  are 
underdeveloped  muscularly  and  hive  not  the  constitutional 
resistance  nor  the  will-power  of  the  average  child.    The  muscle 


TMATHENT   Or   lOUNI)   BACK    ANll   ST(K)PKr)    Sllol  LIIKKS      257 

fatiuuc-  Ihat  comiHi  on  from  ihc  strainiil,  lixwl  iKwiiions  amonR 
schcxj  chililren  must  he  au.icliil  l)y  e\iry  a\ailal>li'  means.  Schcx)l 
fumiturt  shoulil  lit  ailjusid  to  prevent  undue  llexion  i>!  the  liark 
an<l  forward  iHrndinK  of  the  heail  durinj}  reading  and  wrilinn. 
Krrors  of  refraction  should  lie  correiti><l.  The  clothinx  *houl.l  !«• 
examined,  anil  when  found  to  Ik-  su|i|«rte<l  from  the  ti|.  of  the 
shoulders,  the  Rarmcnts  shoulil  lie  altere<l  to  hrinj!  the  pressure  in 
toward  the  root  of  the  neck,  instead  of  out  on  the  shoulders. 


KiR.  30(1.— Corrct  standing  ixMluro.  Fii;, 


t  stnniling  ptxittire. 


(2)  fiAcrrivc.— In  the  treatment  liy  exercise,  expansion  of  the 
lungs  by  deep  breathing  to  round  out  the  flattened  chest  should 
be  emphasiEcfl.  These  exercises  ha\e  been  descr.bcd  in  Chapter 
XI\'.  The  correct  standing  position  anil  carriage  of  the  body 
should  be  continually  and  persistently  insiste<l  upon.  This 
must  not  be  done  bv  contracting  the  retractors  of  the  shoulders, 
but  rather  by  brinRinf;  in  the  chin  and  forcing  the  thorax  forward 
and  upward  (Fig.  206).  as  already  described.     The  muscles  of  the 


I 


»58 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


upper  back  must  be  strengthened  to  carry  out  their  function  of  sup- 
port, and  the  abdominal  muscles  must  be  developed  and  trained 
to  overcome  the  weak  and  relaxed  carriage  of  the  protuberant 
belly.  The  following  exercises  would  constitute  a  daily  prescrip- 
tion : 

Exercise  I. — Patient  standing  in  his  habitual  faulty  position 
(Fig.  208).  Place  the  hand  about  one  inch  in  front  of  the  sternum, 
and  tell  him  to  raise  the  chest  and  shove  it  forward  to  touch  the 


Fig.  ao8. — DiaRram  showing  iW  rela- 
tion of  the  head,  thorax,  and  i«lvis  in  the 
incorrect  standing  position. 


Fig.  339. — Diagram  showing  the  t«U- 
tion  of  the  head,  thorax,  and  [lelvis  in  the 
correct  standing  position. 


hand  without  swaying  the  body.  In  doing  this  at  first  he  will  try 
to  draw  the  shoulders  back,  contracting  the  trapezius  and  rhom- 
boids. This  fault  must  be  overcome  at  the  very  lieginning,  and 
the  shoulder  muscles  must  be  kcjit  relaxed.  Gradually  increa.se  the 
distance  to  which  he  can  bring  the  chest  forward,  repeating  it 
again  and  again  until  he  can  take  the  position  without  difficulty 
and  without  contracting  the  muscles  of  the  back.  While  in  this 
position  make  him  breathe  deeply  fiv6  times  and  then  relax.  This 
should  be  done  before  a  mirror,  so  that  he  will  recognize  the 


TREATMENT   OF   KOfND    BACK    AND   STOOPED   SHOULDERS      259 

feeling  of  the  correct  posture  and  associate  it  with  the  proper 
att.tucle,  as  seen  in  the  glass.  He  should  then  try  to  take  it  without 
looliing  at  the  mirror.  This  posture  should  be  drilled  into  him 
imtil  ,t  becomes  habitual,  and  until  he  can  maintain  it  without 
discomfort. 

R.  J.  Roberts,  of  Boston,  is  accustomed  to  tell  his  young  men 
to  press  the  back  of  their  neck  against  their  collar-button,  con- 
sKlcrmg  this  as  the  keynote  of  the  jjosition.    In  whatever  way  it 


is  accomplished,  the  ol)ject  is  to  get  the  proper  relation  between 
the  thorax  ami  the  |)elvis. 

.After  repeating  Exercise  i  twenty  times  take  Exercise  2. 

Exercise  //.—.Arms  forward  raise,  upward  stretch,  rise  on 
tip-toe,  inhale.  Sideways  lower,  slowly  press  the  arms  back 
Exhale  (Figs.  164,  165-168). 

This  exercise,  when  done  correctly,  expands  the  chest,  bringing 
in  all  the  extensors  of  the  back  and  the  levators  of  the  shoulders. 


ate 


EXERCISB   IN    KDICATION   AND   MEDICINE 


Exercise  ///.—Patient  standing,  arms  down  and  back,  lingers 
interloclicd  and  palms  outward  (Fig.  2io).  Extend  the  neck,  roll 
the  shoulders  back  and  forearms  into  supination,  the  palms  bemg 
first  in,  then  down,  and  then  out  (Fig.  211).  Reverse  to  starting 
position  and  relax. 

This  exercise  is  i)articularly  valuable  lor  projecting  the  chest 
forwaril,  stretching  the  shortened  ligaments,  and  drawing  in  the 
alxlomen.  Care  should  be  taken  to  have  the  chin  i)ressed  back- 
ward when  the  arms  are  brought  downward  and  turned  outward. 
In  resistant  cases,  where  this  exercise  cannot  Ije  done  with  the 
fingers  interlocked,  a  handkerchief  tied  in  a  loop  may  be  sub- 
stituted and  held  in  the  fingers.     iSee  Fig.  270.) 


E.\rriisr  /l'.  -Patient  standing  with  the  arms  at  the  sides. 
.\rms  sideways,  raise,  ui)ward  stretch,  inhale,  forward  bend,  and 
rise.     .\rms  sideways  lower.     Exhale.     iSee  Figs.  i6(;  and  1 70.1 

In  tliis  exercise  the  lungs  are  filled  when  the  chest  is  in  tlie  most 
fa\oral)le  jiosition  for  expansion.  The  lireath  is  retained  when 
the  trunk  is  fitxed.  forcing  the  air  into  tlie  cells  of  the  lungs  under 
|,ressure.  The  bending  and  rising  bring  into  powerful  action  tlie 
extensors  of  tlie  liack  and  neck  and  the  retractors  of  the  shoulders. 

E.\rr<ise  1'.— Patient  lying  prone  ujion  a  couch  with  llie  feet 
strapped  or  fixed  liy  an  assistant.  Hands  clasped  behind  the 
head.  Raise  the  head  and  extend  the  spine,  pressing  the  elbow.^ 
backwarii  (Fig.  212).     Relax. 


TREATMENT   OF   ROUND    BACK    AND   STOOPED   SHOILDERS      261 

This  exercise  is  a  severe  one  on  the  extensors  of  the  bacl<  and 
the  retractors  of  the  shoulders. 

Exenisr  17.— Patient  lying  in  a  prone  jjosition,  arms  at  the 
sides.  Raise  the  head  (Fig.  214),  lirinKinj;  the  arms  forward 
(Fig.  215;.     Imitate  the  breast  stroke  in  swimming  (Fig.  216). 


In  this  exercise  the  erector  sjjinie  is  kept  in  static  contraction, 
'vhile  the  retractors  of  the  shoulder  arc  alternatelv  contracteil  and 
relaxed. 


Slrttching  exercises  that  re(|uirc  the  services  of  an  assistant 
or  a  machine  designed  for  the  jiurposn  should  be  associated  with 
these  voluntary  movements.  Sylvester^  method  of  artificial 
respiration  (Figs.  171  and  172)  may  l)e  employed  with  go<xl  elTect, 
the  upper  dorsal  region  being  supported  by  a  hard  pillow,  the 


26a  EXERCISE  IN   EDUCATION   AND   MEDICINE 

surgeon  pulling  at  the  end  of  the  upiwr  movement,  stretching 
the  thorax  to  its  utmost.  The  intercostal  machine  (Fig.  217)  [s 
invaluable  for  securing  the  same  kinil  of  movement.  Zander's 
machine,  the  "  tower  "  (Fig.  38,  V-  67) ,  straps  the  shoulder  backward 


and  forces  forward  the  rest  of  the  body,  imitating  closely  the 
movement  and  rhythm  of  ordinary  respiration.  The  quarter-cir- 
cle (Fig.  29,  p.  60)  is  another  gymnastic  machine  designed  to  give 
breathing  exercises,   with   the   body   held   in    an   ovcrcon-cted 


Fig.  316. 


position.  Taylor's  "spinal  assistant"  (Fig.  218)  produces  the 
same  effect  bv  susp^ndin;;  the  weight  from  the  arms  with  ac- 
cented pressure  on  the  dorsal  region,  cither  from  behind,  forward, 
or  laterally,  as  shown  in  the  illustration. 


TREATMENT  OF  ROUND  BACK  AND  STOOPED  SHOULDERS  l6i 

G.  W.  Fitz,  as  a  result  of  an  exhaustive  investigation,  came 
to  the  conclusion  that  the  pectoral  muscles  were  not  guilty  of 
causing  round  shoulders,  as  had  been  previously  supposed,  and 
condemns  those  stretching  movements  in  which  the  body-weight 
is  carried  by  the  hands  as  having  but  little  effect  on  the  serratus 
magnus,  which  he  considers  to  be  the  muscle  chiefly  at  fault. 


lil 


Fig.  ai7. — Triplicate  chest  weiffht,  overhead  or  intercostal   atarhmerit. 


The  main  value  of  these  stretching  movements  is,  however,  on 
the  ligaments,  rather  than  on  the  muscles. 

In  slight  cases  of  round  shoulders  the  strapping  described  by 
Goldthwait,  to  draw  the  shoulders  backward,  is  of  real  value. 
It  is  composed  of  firm  webbing,  one  inch  wide,  carried  as  a  loop 
around  each  shoulder,  the  bands  crossing  in  the  back  and  being 
attached  to  the  belt  of  an  ordinary  stocking  supporter.  The 
attachment  of  the  shoulder  strap  to  the  belt  should  be  at  the  side, 


964 


EXEBCISE  IN   EDUCATION   AMD  HEDICOE 


directly  over  the  stocking  straps,  and  the  belt  should  be  worn  about 
the  hips  and  not  about  the  waUt,  as  is  usual.  The  straps  should 
be  sewed  where  they  cross  at  the  back,  over  the  angles  of  the 
scupula;,  but  should  not  be  sewed  where  they  cross  in  the  mid- 
line. This  aUows  body  movements,  both  to  the  side  and  forward, 
without  straining  upon  the  straps  or  changing  the  position  of  the 
belt  level. 


rii.  «i».— Tajtor'i  •pind  HUUiit  tor  suspension  and  kicral  pressure 


For  more  resistant  cases,  where  very  active  stretching  is 
necessary,  Lovett's  apparatus  is  the  best.  It  consists  of  an  oblong 
gas-pipe  frame.  Hinged  to  this,  near  the  middle,  is  another 
section  of  gas-pipe  of  the  same  shape  and  size  as  the  upper  haJf  of 
the  frame.  To  this  movable  section  is  fastened  at  right  angles  a 
gas-pipe  bridge  rising  ab6ut  eighteen  inches  above  it  and  movable 
on  it  (Fig.  519).  When  prepared  for  use,  two  strips  of  webbing 
lying  one  over  the  other  run  from  each  of  the  two  buckles  at  the 


TUATHENT  0»  ROUND  BACK   AND  STOOPED  SBOULDESS     ^65 

bottom  end  of  the  frame.  The  lower  pair  are  tightly  drawn  and 
run  through  buckles  at  the  upper  end  of  the  movable  section. 
The  upper  two  are  loosely  fastened  to  the  bridge.  The  patient 
is  laid  face  downward  on  the  webbing  strips,  protected  by  a  piece 
of  sheet-wadding  if  uncomfortable.    The  thighs  are  flexed  and 


-Appvatiu  for  Btntcfaing  round  shoulden  (modi&ed  from  Lovctt). 


the  feet  rest  on  the  floor,  so  that  the  lumbar  spine  is  flattened. 
Two  pieces  of  webbing  are  placed  over  the  middorsal  region  from 
side  to  side,  tied  to  the  lower  non-movable  frame  on  each  side, 
thus  furnishing  the  resistance  for  the  straightening  of  the  spine 
when  the  upper  end  of  the  movable  frame  is  raised,  carrying  with 


.'-tV 


ll 


j66  exercise  in  education  and  medicine 

it  the  head  and  upper  chest.  After  the  patient  U  in  pUcc,  the 
upper  part  of  the  Irame  is  lifted,  the  amount  of  force  perm.^.ble 
^ing  not  beyond  the  point  of  tnild  discomfort.  Several  stretch.ngs 
„rmade  of  a  few  seconds  each,  the  movable  part  of  the  frame  bemg 
let  <lown  to  rest  the  patient. 

Flexible  round  shoulders  in  most  cases  yield  to  e«rc.se  alone, 
extending  over  a  perio<l  of  three  to  six  months  of  daily  treatment, 
but  U  may  be  ad^sable  to  maintain  the  improvement  for  a  tune 
"r  means' of  some  such  simple  brace  as  the  "-.d-"'-'  ^^ 
Goldthwait,  although  fixation  without  exerc.se  .s  .rrat.onal  and 
L  s  the  condition  worse  than  it  found  it.  Some  --^n  -- 
will  require  stretching  by  the  Lovett  apparatus  and  fixaUon  ,n 
the  corrected  jK^ition,  combined  with  vigorous  development  of 
the  muscles  of  the  back  and  prolonged  training  m  the  corrected 

"''tsetses  in  which  there  is  structural  deformity  have 

been   treated  by   cutting  the   coraco-acromial   I'Sament,   or  an 

•    ^at  on  on  the'deformed  scapulas  as  described  by  GoldthwaU 

Z  such  cases  are  the  exception  and  nee<l  not  enter  mto  the 

"Tftiractive  treatment  has  cea^d,  the  patient  should  be  kept 
under  super^■ision,  reporting  progress  at  least  once  a  month  for 

'"Tis'the  rule,  rather  than  th.  exception,  to  find  associated  with 
round  shoulders  some  inequality  in  their  height.  In  looo  con- 
secutive examinations  of  supposedly  normal  young  men,  the  r.ght 
Z  der  was  low  in  ,40  cases  and  the  left  low  m  .0  cases,  and 
Lilors  tell  me  that  it  is  almost  the  rule  to  put  extra  paddmg  m 
the  right  shoulder  of  coats  for  the  sake  of  appearance. 

The  causes  of  an  irregularity  varying  from  three-fourths  to 
two  inches  are  sometimes  difficult  to  disentangle,  but  the  carrymg 
of  weights,  like  school-books,  and  bad  hab.ts  m  s.tung  and  s  and^ 
ing  are  among  the  most  potent.  The  position  of  the  ch,l,l  s.ttmg 
at'the  school  desk  during  writing  favors  it. -ce  the  lef  arm  and 
shoulder  are  supported  and  the  right  lowered.  Hab,tuals^ndmg 
with  the  weight  on  the  right  leg  contributes  to  a  good  many  cases. 


TREATMENT   OF    ROUND    BACK    AND    STOOPED   SIIOl'LDERS      36? 


as  will  \k  seen  in  the  description  o(  scoliosis,  but  weights  carried 
in  the  hand  or  pressure  on  the  right  shoulder  are  the  most  direct, 
and  it  is  a  common  thing  to  sec  this  deformity  in  soldiers  after 
carrying  the  rifle  and  bandolier  during  long  marches.  Fig.  J20 
shows  a  man,  otherwise  |)owerful,  symmetric  and  well  developeil, 
who  acquired  it  in  two  years'  active  military  service  in  South 
.\frica,  during  which  he  had  to  make  long  marches  with  his  rifle 
ami  cartridge  belt  pressing  down  on  the  right  shoulder. 

The  great  specialization  of  some  games 
in  which  the  right  arm  is  almost  exclusively 
used  is  blame<l  for  many  cases.  Fencing, 
baseball  pitching,  and  putting  the  shot 
are  ready  examples. 

In  response  to  an  inquiry  sent  to  21 
men  who  had  the  left  lowercfl  only,  3 
acknowledged  to  left-handerlness. 

The  patient  ])laced  Ijeforc  a  mirror  can 
almost  always  assume  the  correct  standing 
ixjsture  by  voluntary  muscular  effort,  but 
to  him  it  docs  not  feel  normal  or  natural, 
and  he  quickly  relapses  if  left  to  himself. 

In  all  straight  and  symmetric  exercises 
the  weaker  side  will  get  more  work  than 
the  stronger,  so  that  movements  described 
for  flat  chest  and  round  shoulders,  all  of 
which  bring  in  equally  the  muscles  of  Ijoth 
sides,  would  be  of  some  value  in  these 
cases.  It  is  necessary,  in  addition  to  this, 
to  develop  the  upper  part  of  the  trapezius, 
the  rhomboids,  and  the  deltoiil  of  the 
lowered  side,  and  the  latissimus  dorsi  and 
inferior  part  of  the  jiectorals  on  the  opposite  side,  and  for  this 
purpose  the  following  exercises  should  be  given  for  a  lowered 
right  shoulder : 

Kxercise  /.—Position,  standing,  arms  down  at  the  side.     Right 
arm  forward  raise;  inhale  (Fig.  221);  rise  on  the  tip-toes;  stretch; 


rij;.  22-j.  -  !.o\vfriiig  of 
the  riKhL  shoulder  from 
carr>-inK  a  rifle  and  pressure 
of  a  bandoUer  for  two  years. 


m 


368 


EXERCISE   IN    EDICATION   AND   MEDICINE 


sideways  lower;  exhale.     The  left  arm  should  Ik*  shove*!  downward 

while  the  right  arm  is  raisetl. 

This  exercise  brinj^s  into  action  the 
u)){)er  part  of  the  trajtezius,  deltoid, 
rhomlxiids,  and  serratus  magnus  of  the 
right  side,  and  the  latissimus  dorsi  and 
lower  ])art  of  the  pectoralis  major  on  the 
left. 

Extnisc  //.—Position,  standing,  arms 
down.  Right  arm  sideways  raise;  inhale; 
forward  bend  (Fig.  222);  upward  stretch; 
arm  sideways  lower;  exhale. 


J'in.  a». 

This  exercise  has  the  same  effect  as  the  first,  with  the  additional 
advantage  of  stretching  the  right  side  of  the  trunk  more  than  the 
left,  as  the  Ixxly  is  bent  forward. 

Exercise  III. — Position,  prone,  lying  on  i)linlh,  right  arm 
elevated,  left  arm  forced  downward,  Kxtcnd  the  neck  and  back; 
relax  (Fig.  224). 

Exercise  IV. — Position,  back  to  the  chest  weight,  floor  attach- 
ment; raise  and  lower  the  right  arm  iFig.  223).  This  brings 
into  action  the  right  deltoid;  the  upper  part  of  the  trapezius;  the 
rhomboids,  and  the  serratus  magnus  of  the  right  side. 


T.KATMKNT   ur    KOUNU   BACK    AND   STOOPED   SHO.Ll.KRS      ,tx, 


Fir.  aaj. 


fiArwiV   I-._ShruRsinK  the  riKht  shoulder  while  hol.lins  a 
tlumb-MI  of  40  or  50  poun.ls  (Figs.  225  and  ..6)  has  the  contrary 


effect  from  continually  holding  the  weight  .nd  keeping  the  muscles 
m  tension.  The  intermittent  contraction  and  rduxation  of  the 
muscles  tend  to  strengthen  and  develop  them,  an,l  so  make  them 


[I      •  n 


270 


EXEICME   IN    EDl'CATtUN   AND  MCOICINC 


bhortcr  when  at  rest,  white  continuous  tension  rapidly  stretchci 
them  and  destroys  their  tonicity. 

The  puttinK  u|>  of  a  light  dumb-lx'll.  five  or  ten  pounds,  from 
the  floor  to  arms'  length  above  the  head,  is  another  valuable 
exercise  iFi);   237). 

The  nautical  wheel  (Fi(?.  34,  p.  6j)  turneil  counter-clockwise 
also  will  help  to  raise  a  lowered  right  shoulder. 


Fig.  315.  Fig.  aae.  Fig.  at^. 

Hanging  exercises,  in  which  the  weight  is  borne  by  the  right 
arm  with  counter-pressure  on  the  left  side,  are  of  slight  assistance 
in  stretching  the  latissimus  dorsi  on  the  right  side,  but  do  not 
affect  the  upper  part  of  the  trapezius  or  the  serratus  magnus,  both 
of  which  are  relaxed  in  this  position. 

The  prognosis  is  good  in  all  cases  if  these  exercises  be  followed 
persistently  and  faithfully  in  the  form  of  a  daily  prescription  for 
three  to  six  months.  Most  of  the  failures  are  caused  by  the 
carelessness  of  both  surgeon  and  patient  and  by  the  readiness  of 
the  tailor  to  act  as  their  accomplice. 


CHAPTER   XVII 

SOOUf^lS-lTS  CAUSES*  VARffiTlES,  DIAGNOSIS, 
AND  PROGNOSIS 

.  /  '  ■  "  '""'  ''^l-''"-  '  walk,  the  general  direction  of  the 
infii'^  ,p.,u.  ■.  ,,.,r,-,-.-,  .  (lescriW  in  the  previous  chapter, 
^■1  the  „.,ee  ror,  -,u  .  .,  ,.  ,1  and  backward  curves  soon  develop 
.V;t  only  n..  ■  Ihere  'k  mduc  eraggeration  or  suppression  of 
ne«-  .L.r  .,  ,.  ;„rt.„|y  sh>,,vn,  but  during  growth  lateral  de^•ia- 
tions  may  ,.ls,.  ,c,  ,,  overstretch  the  supporting  muscles  an.l 
ligament.,  n  ,  ,,,„  ,„  .y,^^^^^  ^^^^  vertebra;  themselves  while  in 
their  plastic  slate. 

The  integrity  of  the  spine  is  protecte<l  against  the  onset  of 
deformity  by  three  lines  of  <lefense  of  increasing  strength-  (,) 
the  muscles  forming  an  advance.1  mobile  series  of  out,x«ts  brought 
into  service,  in  relays,  powerfully  but  intermittently;  (j)  the 
ligaments  more  resistant,  but  less  mobile,  requiring  long-continue.1 
and  persistent  attacks  to  overcome  their  normal  protective  action- 
(J)  the  bones,  which  may  be  compared  to  the  citadel,  yielding  to 
the  influence  of  .leformity  only  after  the  other  two  lines  of  defense 
have  long  since  Been  carried.  When  they  have  a<lapted  themselves 
to  the  deformity  and  have  become  set  in  their  distortion,  treatment 
can  hope  to  1«,  at  t«st,  only  cosmetic  in  character,  to  conceal  the 
deformity  rather  than  to  correct  it. 

The  muscles  acting  upon  the  spinal  column  fall  naturally  into 
three  groups:  (,)  The  anterovertebral,  consisting  of  the  psoas 
in  the  lumbar  region,  the  three  scaleni,  the  longus  colli,  and  the 
sternomastoid  in  the  cervical;  (2)  the  spinoscapular  in  two  layers- 
the  trapezius  and  latissimus  dorsi  superficially,  and  the  rhomboids 
and  levator  anguli  scapula;  beneath  them;  (3)  the  spinal,  con- 
sisting of  the  two  posterior  serrati,  superior  and  inferior,  and  the 


|l' 


37' 


EXERCISE   IN   EDUCATION  AND   MEDICINE 


erector  spins  mass,  thick  and  fleshy  in  the  lumbar  and  cervical 
regions,  but  thin  and  tendinous  in  the  dorsal. 

Some  of  the  deeper  muscles  well  developed  in  the  cervical  and 
lumbar  regions  become  ligamentous  in  the  dorsal,  illustrating  the 


Fig.  2iR.— The  anterovertebral  muscles,  showinR  Ihe  ilioiffloas  and  quadratus  lum- 
borum  in  Ihe  lumbar  rcRion,  and  in  the  rervical  the  lonnus  colli,  the  scalenus  anticus 
medius  and  iwsticus  on  the  right,  and  the  atcrnomastoid  on  the  lelt. 

principle  of  regression,  and  this  is  significant  of  the  relative  amount 
of  movement  in  the  three  regions. 

Movements  of  the  spine  are  flexion,  extension,  side  bending, 
and  torsion. 

Flexion  takes  place  mostly  in  the  lumbar  and  cervical  regions, 
the  dorsal  backward  convex  curve  being  accentuated  but  slightly. 


SCOUOSIS-ITS  CAUSES,    VARIETIES,    DIAGNOSIS,    PSOGNOSIS     273 

Extension  is  almost  entirely  in  the  lumbar  and  cervical  regions 
even  in  backward  contortionists,  who  can  place  the  head  on  the 
hips,  the  dorsal  region  remaining  comparatively  fiwd  (Fig.  331) 
In  side  bending  from  the  flexed  position  of  the  spine  the  lumbal 


ri.h,''.!?'  "■'-'^^'"•P"^"''  »"■!  dfP  layers  „(  .he  .pinoscapuUr  ■nu.cle,;  on  th. 
r«ht  the  lat„.,mu,  do,,,  and  Irapc^ius,  „„  ,he  left  >h.  ,h„™boideu,  major  and  minor 
■nd  the  levator  anguli  scapulc. 

region  is  locked,  and  the  movement  is  in  the  dorsal  region  more 
than  lower  down.  It  is  accompanied  by  rotation  of  the  bodies  of 
the  dorsal  vertebra;  to  the  convex  side  of  the  lateral  curve.  Side 
bending  from  the  position  of  extreme  extension  takes  place  in  the 
lumbar  region  almost  entirely,  the  dorsal  vertebra  being  locked 


274 


EXERCISE  IN  EDUCATION  AND  MEDICINE 


Rotation  of  the  bo<lifs  of  the  lumbar  vertebra;  is  to  the  concave 
side  of  the  lateral  curve. 

Torsion  in  the  erect  position  is  greatest  in  the  cervical  region, 
gradually  disappearing  through  the  dorsal.    In  the  lumbar  region 


F.O.  „,,.-The  erector  .pm.  covered  by  (he  «-rrati  pMtlci.  .uperior  >nd  inferior.    On 
the  left  the  ainchments  are  shown  diagrammalically 

it  is  diminished  by  fle.sion  or  extension  and  is  slight,  even  in  the 
erect  position. 

The  most  freely  movable  regions  are  most  abundantly  pro- 
viied  with  muscles,  and  it  is  to  the  analysis  and  application  of 
their  action  that  treatment  of  deviations  by  exercise  must  be 
directed. 


SCOLIOSIS— ITS    CAUSES,    VARIETIES,    DIAGNOSIS,    PROGNOSIS     275 

The  frequency  of  scoliosis  among  children  and  youths  may  be 
gathered  from  the  fact  that  in  an  examination  of  122  high-school 
boys  enterefl  for  an  athletic  meet  I  found  it  in  32  cases,  or  19  per 
cent.  In  an  examination  of  446  athletic  college  students  it  was 
found  in  ig  per  cent.  In  another  series  of  200  college  students  it 
was  well  marked  in  over  8  per  cent.,  and  slight  in  an  additional 
16  per  cent.  In  a  girls'  high-school,  out  of  160  examinations,  it 
was  found  in  31  cases,  or  19  per  cent.,  accompanied  by  severe 
backache  in  1 7  cases.  The  figures  of  other  observers,  like  Guillam, 
Krug,  Hagraan,  Kalback,  .Schotter,  Eulenberg,  Roth,  and  Whit- 
man, give  an  average  of  alwut  27  per  cent,  among  sch<x>l-children 


Fig.  331.— In  ovcTvxtension   of  ihe  spine   the  bending  takes  place  principally  at  the 
neck  and  loins  (Dwight). 


and  place  the  periotl  of  greatest  frequency  between  the  ages  of 
seven  and  fourteen. 

The  causes  of  scoliosis  are  both  congenital  and  acquired. 
Among  them  may  be  mentioned  wry-neck,  defective  hearing  and 
vision,  asymmetry  (Figs.  232  and  233)  or  faulty  development  of 
the  bones,  like  rickets,  dislocation  of  the  hip,  arthritis,  and  uneven 
development  of  the  lower  extremities  from  joint  disease  or  other 
causes.  Astigmatism  has  been  given  a  large  jilace  in  the  caus- 
ation of  scoliosis  l)y  Gould,  who  has  well  described  the  tilting 
of  the  head   in  such   cases,  particularly  when   reading  or  writ- 


276 


EXERCISE    IN    EDICATION    AND    MEDICINE 


ins;.     His  experience  has  been  confirniecl  in  case  rc|K>rts  (luoied 
by  Rogers.' 

•'Case  /.—October  7,  1901,  H.  H.,  aRcd  seventeen,  .\meri- 


Fig.  333. — Lateral  rurvaturc  frtini  un- 
even extremities  and  deformefi  iielvis.  The 
black  spots  mark  the  iiosterior  suiierior 
spine  of  the  ilium. 

can  school-girl,  complainetl  i)f 
jjain  through  eyes  anil  head, 
extending  down  the  back,  and 
aggravated  by  study.  Some 
months  previously  her  phys- 
ician noticeil  a  lateral  curva- 
ture of  the  spine,  anil  an 
attempt  had  been  made  to 
correct  this  deformity  I'V  the 
daily   use  of  calisthenics.     She 

was   wearing  glasses  given   her   \,y   an   optician.   ().    D.       0.50 
C.   90  -  O.   S.       0.75   C.   ijo".   and   with   tlwm   got  0.7   vision, 

1  ■■  Ji.urnal  of  the  .\mfriian  Meili.al  Ass  .rialion,"  July  it,.   i.;o7. 


t'iR.  3Zi- — The  result  of  raisinK  the  fixtt 
three  inrhes  to  brinst  the  spines  of  the  ilium 
10  the  same  level 


SCOLIOSIS— ITS   CAUSES,    VARIETIES,    DIAGNOSIS,    PROGNOSIS     277 

l>ut  there  was  noted  at  once  a  tendency  to  tilt  the  head  to 
one  side  when  using  them.  After  examination  under  a  mydriatic 
she  was  ordered  O.  D.  -I-  i.o  (  •  )  0.50  C.  75°;  O.  S.  +  0.50 
(  +  )  1.0  C.  100°  for  constant  wear. 

•■April   19,    1902:    The  patient   had   improved  preatly,   the 
asthenopia  was  gone,  and  the  spinal  defect  was  not  noticeable. 


s|,initi  ilcformily 


The  gymnastic  exercise  had,  however,  Ijeen  continued,  and  the 
beneficial  result  wa-;  attributed  to  this  alonu." 

It  is  to  l>ad  jjoslure.  long  continued,  in  standing,  sitting,  and 


378 


EXERCISE   IN    EDUCATION   AND  MEDICINE 


I 


lying,  joineil  with  the  carrying  of  weights  in  the  hands  or  sus- 
pcndetl  from  the  shoulder,  that  we  must  look  for  the  origin  of  the 
vast  majority  of  cases,  which  may  be  classed  under  the  general 
heading  of  the  Sfo/ww's  of  fatigue. 

A  frequent  fault  in  the 
standing  posture  is  th»-  habit- 
ual employment  of  one  leg, 
usually  the  right  one.  as  a 
base,  the  other  foot  being  used 
as  a  prop  (Fig.  235).     This  pro- 


Fig.  335. — Lowerirx  of  the  riRht  shoul- 
der from  resting  the  weight  on  the  right 
leg.     One  way  in  which  a  C  curve  begins. 


Fig.  336. — Pose  from  ^n  .intitjuc  statue 
of  a  Ijoy  illustrating  thi-  attitude  of  r(.st 
with  the  weight  on  the  right  foot.  The 
right  hip  projetted  and  right  shoulder 
lowered,  forming  a  C  curve. 


duces  a  C-shaped  cur\e  with  marked  lowering  of  the  right 
shoulder  and  prominence  of  the  right  hip.  Many  children 
assume  this  position,  in  which  the  strain  is  Ijorne  Ijy  the 
ligaments  of  the  hip  and  spine  .for  long  perioris,  and  feel 
imcomfortable  when  the  weight  is  transferred  to  the  other  foot. 


SCOUOSIS-ITS   CAUSES,    VARIETIES,    DIAGNOSIS,    PBOGNOSIS     279 

Such  cases  are  nearly  always  accorapanici  by  rounding  of  the 
shoulders,  flattening  of  the  chest,  protrusion  of  the  abdomen, 
and  rotation  of  the  Nertebr=e,  all  sign.,  of  muscular  fatigue  and 
ligamentous  strain. 

The  sitting  posture  is  beset  with  possibilities  for  deformity 
The  comnion  habit  of  sitting  with  one  foot  tucked  up  on  the  seat 
IS  respons^le  for  some  cases,  but,  ateve  all.  the  compulsory  holding 
«f«iy  »«ed  position  for  long  ,.eriods  of  time.  We  know  that  if  we 
hold  the  arm  out  at  right  angles  the  pair  ami  fatigue  soon  become 
intolerable,  and  few  can  stand  the  strain  so  long  as  five  minutes. 
The  greatest  stram  falls  u,»n  the  dehoid,  which  has  no  relief  from 
continuous  action.  The  same  cm,dition  c^rurs  in  the  back  and 
shoulders  of  the  school-child  forced  to  remain  sitting  for  any 
unusual  length  of  time.  ' 

The  complicated  system  of  spinad  muscles,  bv  working  in  relays 
postpones  fatigue  very  considerably,  the  slighter  change  of  move- 
ment bringing  into  action  a  new  set  and  relieving  the  tired  ones 
and  this  consunt  desire  for  rest  by  movement  i-  the  most  striking 
quality  of  all  young  animal  life. 

With  the  K'inning  of  school-life  the  child  is  made  .0  sit  from 
hree  to  six  hours  with  but  momentary  rests  at  long  inten-als,  ami 
the  resultant  restlessness  must  be  suppresse,!  bv  the  teacher  for 
tl.e  sake  of  discipline.  The  rapid  fatigue  of 'the  umleveloped 
muscles  and  the  irregular  compression  of  the  growing  bones  go 
far  to  hx  the  faulty  posture,  especially  in  those  who  are  weak  and 
delicate.  The  process  of  collapse  and  tiring  of  the  spinal  mu.scles 
during  writing  is  well  described  bv  Fahrner- 

"Before  writing  begins  children  sit  perfectly  upright  with 
both  scapula,  thrown  back  equally.  .Vs  soon  as  wxiting  begins  all 
children  move  their  heads  slighdy  forward  and  to  the  left  Soon 
head  after  head  drops  from  the  rapid  fatigue  of  the  neck  muscles 
In  a  short  time  the  back  also  collapses,  so  as  to  hang  from  the 
shoulder-blades  supported  by  the  up,H.r  arm.  Then  two  distinct 
types  of  posture  are  seen.  Those  writing  on  the  upper  par.  of  the 
page  support  themselves  upon  the  riesk.  and  the  rounded  back 
curves  forward.    The  eyes  are  three  or  four  inches  distam  from 


aSo  £XEXC»E  IN  EDUCATION   AMD  MEDICINE 

the  desk,  and  the  support  is  from  three  points— the  left  elbow, 
the  chest,  and  the  right  forearm  slightly.  When  at  the  bottom  of 
the  paper,  they  lose  their  third  support  and  have  the  left  elbow 
alone.  .\dd  to  this  a  twisting  or  skewing  of  the  back  towartl 
the  right.  The  head  is  Ijent  toward  the  left  shoulder,  and  the 
eyes  brought  within  six  inches  of  the  japer.  The  onset  of  this 
deformity  is  hastened  tiy  mental  fatigue,  which  is  faithfully  re- 
flecte<l  in  the  posture,  the  face,  and  the  general  listlessness  of 
the  child." 


-A  double  rurvatuir  enrouraRed  by  bcd-prntiirc.  is  seen  in  the  upper  picture, 
and  corrected  by  lurninK  over  on  ''e  oihf,  side  (Fitz). 

The  influence  of  a  bad  sleeping  jmsture  in  tlic  causation  of 
curvature  has  been  well  pointed  out  l)y  G.  \V.  Fitz,  Boston 
(F'g-  237)-  The  hips  and  shoulders,  l)eing  the  broadest  part  of 
the  trunk,  serve  as  ixiints  of  suiiport,  ami  leave  the  middle  portion 
of  the  body  suspended  between  them,  and  as  the  period  of  sleep 
occupies  one-half  to  one-third  of  the  child's  growing  time,  this 
influence  is  of  importance.  Observations  on  the  attitude  of  320 
healthy  sleeping  cliildren  (156  lioys  and  164  girls),  made  by 
Dr.  E.  G.  Brackett,  showed  that  aljout  20  per  cent,  more  lie  on 
the  right  than  on  the  left  side,  while  more  lie  on  the  back  than  on 


SCOLIOSIS-,TS   CAUSES,    VAWETIES,    mACNOSIS,    PROGNOSIS     jgr 

either  side.  The«  figures  wore  contirme,!  by  Hare,  but  the  greater 
frequency  of  the  lying  position  on  the  right  si.ie  is  ,,artly  explain^ 
by  the  fact  that  the  boys  obsend  were  all  requirJl  to  L  u^n  t^ 
nght  sKle  when  they  went  to  be.1  to  prevent  conversation.  Two 
hou^  later  they  ha.l  turned  on  the  face,  the  back,  or  the  left  side 
As  wdl  be  seen  by  the  illustration  a  patient  with  left  convex 
curve  m  t^he  lower  dorsal  region  should  not  lie  habitually  u,«n 


Fin.  3^K. 

'' """   '"'""""■         '■'I-''  -•w-SrurverauMclbyunL-vrasup 

|«irl  of  ihc  iirlvis  in  o  normal  indivi.liial. 

n.J,7'T"  "^^  ^.^'"  "'  "'"'"  ••"''  "f  'he  spinal  column,  the 
most  flexible  parts  bemg  in  the  lumbar  and  cer^■ical  regions  If 
.t  begms  ,n  the  cervical  region,  from  torticollis  or  from  e«  defects 
as  pomted  out  by  Gould,  other  curves  will  ,.  secon.lar'v.  whi  •  ; 
tl^e  curvature  begms  in  the  lumbar  region,  from  une,,ual  suppor 
of  he  pe,v,s,  ether  m  sitting  or  standing,  the  dorsal  curva.ur  vil, 
agam  be  econ.lary.  An  S-shaped  curve  can  be  produced  ex- 
perimenta  ly  by  raising  the  left  si.le  of  the  sea.  to  L  the  pel  ^ 
makmg  a  lumbar  curve  with  the  convexity  to  the  right  ami  a 
compensating  curve  in  the  opposite  direction  (Figs.  .,8   239. 


•8a 


EXEICISE  IN   EDUCATION   AND  HEOKINE 


Scoliosis  is  frequently  found  in  more  than  one  member  of  a 
family,  in  twins  or  sisters,  in  mother  and  daughter,  or  aunt  and 
niece,  so  that  such  facts  should  be  obtained  at  thie  examination 
as  well  as  the  susceptibility  to  illness  and  fatigue,  rapidity  or 
retartlation  of  growth,  and  time  of  dentition.  Signs  of  rickets, 
like  bowlegs,  the  "rosary,"  or  the  characteristic  shape  of  the 
(  head,  should  be  well  noted,  and  the  history  of  any  severe  con- 

.  I  stitutional  diseases,  as  well  as  the  general  habits  of  life,   such  as 

I  J,  the  length  of  the  school  hours,  the  amount  and  nature  of  exer- 

cise, and  the  standing  and  sleeping  posture.  The  mother 
should  be  asked  how  the  cur\ature  was  noticed,  for  it  is  frequently 
discovered  first  by  the  dressmaker  in  some  casual  way,  such  as 
the  slipping  of  the  clothing,  inequality  of  the  two  sides  of  the  skirt, 
or  unevenness  of  the  shoulders,  and  in  all  such  case  s  it  has  probably 
existed  for  a  long  time  unrecognizc<l.  The  patient  should  then 
be  stripped,  the  length  of  the  legs  measured,  the  presence  or  absence 
of  flat-foot  should  be  observed,  as  well  as  any  marks  on  the  body 
from  pressure  or  faulty  support  of  the  clothing.  The  spinous 
processes  should  then  be  marked  by  a  flesh  pencil,  and  the  levels 
of  the  shoulders  and  inferior  angles  of  the  scapula;  should  be  noted, 
while  the  patient  stands  in  a  natural  position  with  the  heels  together. 
Slight  projection  of  one  hip  can  be  quickly  detected  by  noticing  the 
variation  in  the  size  and  shape  of  the  space  between  the  arm  and 
side,  seen  from  behind,  as  pointed  out  by  Jakob  Bolin.  Flexi- 
bility should  be  tested  by  having  the  patient  bend  to  either  side 
and  then  forward,  with  the  knees  straight,  the  Adams'  position, 
'},  which  best  displays  any  rotation;  and  the  examiner's  hands  may 

:  j;  pass  up  and  down  the  sides  of  the  spine  to  feel  any  irregularity. 

i]  The  habitual  posture  should  then  be  found,  and   the  patient 

placed  in  the  best  possible  position,  which  should  be  the  keynote 
for  future  treatment,  as  Bemartl  Roth  has  so  well  insisted. 
Before  beginning  a  course  of  treatment  the  extent  of  the  cur- 
j  vature  should  be  recorded  if  we  are  to  follow  the  effects  of  treat- 

ment. This  record  must  show  the  difference  in  the  height  of  the 
acromia  and  inferior  angles  of  the  scapula?,  the  deviation  of  the 
spinous  processes  from  the  straight  line,  the  difference  in  outline 


SCOUOSI8-ITS   CAUSES,    VARIETIES.    DIAONOSIS,    W00NOSI8     jgj 

•nd  level  of  the  hip.  and  iliac  crest*,  and,  .gain,  the  picture  will 
not  be  complete  unless  rotation  of  the  vertebra;  is  shown  in  both 
the  domi  and  lumbar  reKions,  ami,  if  necessary,  the  condition  of 
the  anterior  and  posterior  cunes. 

For  this  pur,K«c  photographs  are  much  employed,  but  the  most 
v.la^  objection  to  their  use  as  routine  practice  is  their  e.,«nse. 
both  m  time  and  money,  the  difficulty  of  getting  them,  and  their 
lability  to  mislead  the  observer  by  imperfection,  or  changes  in 
the  lighting  of  the  figure  at  .lifferent  times.     Spellissy  has  devised 
a  uniform  photographic  method  which  would  be  of  value  if  the 
following  conditions  were  observed:  (,)  A  Man.Urd  focal  length 
of  lens;  (,)  a  standard  focus  ami  distance  of  subject  from  lens 
ront;   j)  a  standard  direction  of  lighting  for  recording  pur,x«es; 
(4)  a  standard  size  of  image  and  of  division  of  chart  for  compar- 
ative  il lustratK>ns,  and  (5)  a  standard  series  ot  ,x,ses  in  faulty, 
habitual,  and  correcte.1  |«sture.     Plumb-lines  are  sometimes  used, 
and  deviations  from  them  are  noted  at  different  levels.    The 
shoulder-levels  have  been  measured  from  the  ground,  and  various 
other  isolated  facts  have  bc^n  taken,  but  these  methods  are  all  im- 
perfect, cumbersome,  and  lack  the  uniformity  necessary  for  com- 
parison  one  with  the  other. 

Bernard  Roth's  plan  of  recordin;;  rotation  by  molding  a 
flexible  strip  of  pure  tin  across  the  back  at  the  desire.1  level,  and 
making  a  tracing  from  this  upon  paper,  is  easv  and  accurate 

Fitz  describes  a  method  of  photographing  the  patient  behind 
a  screen,  consisting  of  a  rectangular  frame  with  threads  strung 
vertically  and  horizontally,  cutting  the  entire  surface  into  s,,uares 
of  one  mch.  A  rapid  method  of  recording  the  deviation  is  by 
attaching  a  strip  of  a.lhesiw  plaster  to  the  spine  and  marking  the 
position  of  the  spinous  processes  on  it. 

The  most  accurate  and  convenient  instruments  are  those 
emploving  the  pantograph  method,  of  which  the  most  elaborate 
IS  that  of  Schulthess,  which  gives  a  life-sized  tracing  of  all  the 
contours.  Its  size  and  ex,,ense,  however,  make  its  general 
introduction  impossible  (Fig.  240). 

An  attempt  has  been  made  to  fulfil  these  conditions  in  an 


MKiocon  nsoimioN  rtsi  ouir 

(*NSI  ond  ISO  IIST  CHART  Nn.  J) 


I.I 


b£  I 


2.0 


^  is 


/APPLIED  IfVMGE    Ini 


B^— '•         leSi   Eail   Wain   Street 
Roch«il«f,   r4*w  York        14609       USA 
.^— .^—         (716)   *e3  -  0300  -  Phofi. 


384 


tXERCISE  IN  EDUCATION  AND  MEDICINE 


instrument  which  I  have  employed  for  some  years.  It  consists 
of  a  horizontal  iron  stand  into  which  a  rigid  upright  rod  is  firmly 
screwed.  To  this  rod  two  jointed  arms  are  attached  by  movable 
collars  clamped  by  thumb-screws.  The  lower  arm  passes  behind 
the  patient  and  fixes  the  hips  by  means  of  clamps,  preventing  any 
sideways  movement.      The  upper  arm  passes  in  front  of  the 


Fig.  340.— Schulthesa  apparmttu  for  recording  lateral  curvature  (LUning  and  Schul- 
theaa). 

patient  and  fixes  the  shoulders.  To  the  collar  of  the  upper  arm 
a  plate  is  hinged  for  the  attachment  of  the  pantograph,  set  to 
make  the  tracing  in  the  proportion  of  i  to  4.  Ruled  paper  is 
stretched  over  the  plate  and  held  by  clips  behind.  The  pointer 
should  be  adjustable  in  length,  short  for  the  tracing  of  the  spine 
and  scapulcc;  and  capable  of  being  lengthened  for  tracing  the 
outline  of  the  shoulders  and  hips. 


SCOUOSK-,TS   CAUSES,    VARIETIES,    DIAGNOSIS,    PROGNOSIS     285 

To  take  a  tracing  the  spinous  processes  are  first  marked  with 
a  flesh-penci  The  patient  is  placed  on  the  stand  with  the  heels 
ogether,  the  hip.  are  clamped  at  the  level  at  the  trochanters,  and 

M  mto  the  habuual  position.    The  line  of  the  spine  is  followed 
by  the  short  pomter  (Fig.  .4, ),  the  gluteal  cleft  and  the  points  of  -Z 


i  h 


scapute  mark.^;  then  an  outline  of  the  shoulders  and  hips  is  rapidly 
traced  by  lengthenmg  the  pointer  to  touch  the  most  pmminent  ^rts 
Cross-secfons  may  be  taken  to  show  rotation  bypassing  the  end  of 
the  pantograph  across  the  back,  at  the  desired  level,  the  patient  bend- 

of  the  back,  showmg  the  difference  in  levels,  deviation,  and  rotation 


(lb 


ii 


(  i 


386 


EXERCISC   I.N    EDLCATION    AND   MEDICINE 


their  txtent  being  to  scale,  anti  estimated  by  counting  the  squares 
on  the  ruled  ])aper. 

These  tracings  should  be  repeateil  from  month  to  month 
throughout  a  course  of  treatment. 

Diagnosis.— Scoliosis  must  be  carefully  distinguished  from 
Pott's  disease  or  tuberculosis,  symptoms  of  which  are  spasm  of 


Fig.  24a. — Making  a  tracing  of  the  rotation  at  the  luml>ar  region. 


the  muscles  and  loss  of  mobility  in  the  spine,  with  pain  on  motion 
or  jar,  pains  in  the  chest  and  abdomen,  fever,  and  impairment  of 
the  general  health.  Lateral  deviations  occur  in  the  course  of  this 
disease,  but  it  is  usually  a  leaning  of  the  body  to  one  side  rather 
sharply,  instead  of  a  true  gradual  curve.  In  later  stages  a  knuckle 
of  bone  develops  at  the  seat  of  the  disease,  but  the  danger  of 
mistaking  it  lies  before  this  has  developed. 


SCOUOS,S-ITS    CAfSKS,    V.«,.T.ES,    DUGNOSIS,    PR<«X„S,S     .8; 

In  Ticket,  the  malformations  of  the  ^■ari„us  bones  may  usually 

^JZir     '  "'""'■"'"'■°"  """  ■"—-«-•"'.  and  the  othi 
consftutiona  symptoms  are  characteristic,  the  cun-es  of  the  spine 


Joii«).  '^     ^"^  """"^  >"=«nient  l,y  immobili^.ion  (Ridlon  and 

In  infantile  paralysis  there  is  a  manifest  loss  of  power  in  the 
affected  muscles,  which  renders  its  diagnosis  comparatively  easy 
pecially  by  the  aid  of  electricity.  In  these  cases  the  deform  f; 
u  ually  becomes  great,  and  the  condition  is  resistant  of  treatm^m 
Curvatures  resulting  from  pleurisy  and  empyema  are  alTays 
toward  he  convex  healthy  side  of  the  chest  (Fig.  .44;  and  are 
easily  distmguished  by  the  history  and  appearance 


Hi 


I 


!£! 


III): 


388 


EXEKCISE   IN  EDUCATION   AND  MEDICINE 


The  most  frequent  form  of  scoliosis  is  the  total  C-shaped 
curve  involving  the  entire  back  (Fig.  245). 

In  his  series  of  looo  consecutive  cases,  taken  from  a  large 
private  practice,  Bernard  Roth  found  523  presenting  this  type; 
329  presented  a  right  dorsal  and  left  lumbar  (Fig.  246);  72  of  his 
cases  showed  a  total  right  curvature,  while  33  might  be  classed 
as  irregular.     This  is  substantially   the  same  proportion  as  in 


^ 


■^ 


Fig.  344.— Tracing  of 
scoliosis  due  to  collapae 
of  right  side  after  empy- 
ema and  resection  of 
ribs. 


; 


Fig.  345. — C  t  irve  in  i 
young  woman. 


ot 

curve. 


Fig.    346.— Tracing 
typical      a-shajied 


Scholder's  examinations  of  school-chiliren  a  I,au.isane.    His  entire 
table  is  as  follows; 

Among  5;i  school-children  with  lateral  curvature,  out  of 
2134  children  examined,  60.3  per  cent,  showed  curves  convex  to 
the  left,  2 1. 1  per  cent,  showed  a  right  convex  curvature,  and 
8.5  per  cent,  showed  compound  convex  curves.     His  totals  are: 


Leit  Convex. 

Total  scoliosis 48.1  per  cent. 

Dorsal  scoliosis 8.4         " 

Lumbar  scoliosis 11.8         " 

Combined  scoliosis 8.5         " 


Right  Citttfex. 
7-8  |>er  cent. 
4-3 

8.3  " 


Tolal. 
56.0  I»er  cent. 
13.7 
30.3 
8.5         " 


The  total  curve  is  most  commonly  found  in  school-children, 
and  is  followed  by  the  right  dorsal  and  left  lumbar.  Transitional 
cases  are  nearly  always  preceded  or  accompanied  by  round  shoul- 
ders, flat  chest,  and  protruding  abdomen,  and  by  general  care- 
lessness in  carrying  the  body  weight  when  standing  at  rest,  as 
m  Fig.  235.  This  alone  would  tend  to  produce  a  well-marked 
total  curve  with  the  convexity  to  the  left.     As  this  posture  becomes 


')UOS,S-m   CAISES,    VARIETIES,    OUONOSIS,    PROGNOSIS     ,89 

fix       he  balies  of  ,he  luml,„  vertebra-  rotate  to  the  left      „!  .hi 

m  facing  a  strong  wind.    This  ca"use's  a 
rotation  of  the  bodies  of  the  cervical  verte- 

T 1°  ""^  "^^^'  '^"y'"S  »"h  i'  the  Ixxlie. 
of  the  dorsal  vertebrae,  producing  the 
characteristic  ri^ht  dorsal  curvature  with 
rotation  to  the  right,  and  followed  by  a 
left  convex  lumbar,  the  level  of  the  great 
est  deviation  in  these  cases  being  usuallv 
from  the  sixth  to  the  eighth  dorsal. 

In  total  curvatures  the  deviation  is 
greatest  lower  down-about  the  ninth  or 
tenth  dorsal,  or  even  at  the  twelfth     In     "•  -'"""  "■"">■"«.. 

la"r"v 'n  '''"'"'■'"'  '™'"  """-=  "''^'o"'"""  "f  "«=  P^'v-  or  i.regu- 

inr^r  ;erir;~ "  -^-"'^  ^""^''"  -•  "--" 
nottr::;T^™Ltrs5:rcar  ^d"^  r™'^-  - 

^^-"j'ui.i-.    in  severe  cases  there  may  be  oressiirp  ii,,r,„  .i, 
roots,  causins  oain     Th„  „    i  ,  pressure  upon  the  nerve- 

breath   is  coiCn'o  ^^  """^  °^  ''"'■«"^'  «■'■"'  ^h°«"ess  of 

ath,^is  common  on  account  of  the  diminished  capacity  of  the 


..  .,-  IraiitiK  illus- 
trating a  C  curve  as  a  result 
of  uneven  Mtremjties. 


39° 


EXERCISE  IN   EL'UCATION  AND  MEDICINE 


lungs  and  interfirence  with  the  heart  action,  but  these  symptoms 
are  [leculiar  to  the  more  aggravated  cases.  As  the  deformity  tends 
to  increase  during  the  growing  jjeriod,  these  symptoms  may  not 
become  insistent  until  the  approach  to  adult  life,  when  the  patient 
is  prone  to  develoj)  phthisis  or  to  have  disturbance  of  the  digestion, 
impairment  of  the  general  vigor,  and  slow  increase  of  asymmetry, 
with  increasing  pain  in  the  back,  as  senile  atrophy  of  the  inter- 
vertebral discs  progresses. 

Prognoiis. — Total  functional  curves  may  continue  as  such 
throughout  life,  increasing  slightly,  although,  as  a  rule,  they  change 
to  structural  curves  and  become  comi)Ound  in  form  as  they  pro- 
gress.    Some  permanent  deformity  is  certain  in  all  cases  where 

V 


;.).\Ma;./.  \ ; 


Fig.  34K. — Courae  of  the  S  curve  under  treatment. 

the  vertebra  have  become  distorted  and  a  functional  cur\e  has 
become  structural. 

By  treatment  all  but  structural  casts  should  be  capable  of 
permanent  cure,  and  even  they  should  be  in  every  case 
greatly  improved,  the  deformity  masked,  and  the  general  health 
and  efficiency  retained.  This  applies  more  especially  to  children 
who  have  not  yet  acquired  their  full  growth.  When  full  growth 
has  been  attained,  before  the  case  comes  under  observation,  com- 
plete cure  is  not  to  be  hoped  for,  and  the  only  thing  to  be  expected 
is  some  improvement  in  the  general  condition  and  a  variable 
diminution  of  the  deformity.  Cases  due  to  infantile  paralysis 
or  to  the  collapse  of  one  side  of  the  chest,  from  empyema,  are 
peculiarly  resistant  and  must  be  treated  w'th  great  caution.  Cases 
due  to  rickets  are  also  resistant,  although  most  of  them  are  capable 
of  considerable  improvement. 


CHAPTER    XVni 

THE  TREATMENT  OF  SCOUOSIS 

The  treatment  of  scoliosis  falls  naturally  into  two  divisions- 

.    The  reormauon  of  the  physical  habits  and  improvement  of 

the  general  condition;   (,)   the  correction  of  the  deformity  by 

ejtercise,  stretching,  and  support.  ''  ^ 


Correct  standing  posture  must  be  taught  by  the  aid  of  a  mirror 
as  descr,bc.l  ,n  the  chapter  on  Round  Shoulders.     This  must  ^ 

x«  ;aC  '''^"  ^"" ""' "'  ^'^^""  ™"' " ''" "-  "-■■"•^'"^ 


I,  r 


a 


391 


EXERCISE  m  EDUCATION  AND  MEDICINE 


Astigmatism  should  be  at  once  corrected  where  it  is  the  cause 
of  tilting  of  the  head,  and  the  habiU  of  school  life  should  be  care- 
fully regulated. 

The  writing  posture  has  been  much  maligned,  and  even  with 
well-fitting  seats  and  desks  the  present  writing  position  is  such  as 
to  favor  the  formation  of  fatigue  scoliosis  to  a  marked  extent. 
Slanting  script  has  been  blamed  as  an  encourager  of  postural 


F%.  JSo-^-Ouuve  of  pottufc  d  body  atid  heul,  the  pAper  thown.  uul  the  pen-holder 
u^kkl  in  ottleT  to  bring  the  writing  field  into  view  (Gould). 

defects,  but  the  directions  given  for  the  correct  writing  position  are 
impossible  from  a  practical  standpoint,  as  has  been  demonstrated 
by  Gould,  who  shows  that  the  hand  in  the  writing  posture,  as 
usually  ordered,  lies  between  the  eye  and  the  writing  field,  which 
is  hidden  by  the  thumb  and  finger  and  the  pen-holder  (Fig.  249). 
As  a  consequence,  the  pupil  turns  the  paper  to  the  left,  and  the 
pen  to  the  right,  accompanying  this  by  twisting  of  the  head  further 
to  the  left,  with  the  chin  tilted  to  the  right  (Fig.  250). 

If  the  paper,  instead  of  being  phiced  in  front  of  the  pupil,  be 


THB  WKATHENT  Of  bCOUOglS 


»9J 


^^'i  'u  m"1  °'  "•  '"■'>'  ""'•  "■"«  '"«^""i«  "«  overcome, 
and  the  child  obtaim  .  clear  view  of  the  writing  field,  the  only 
po«.bk  defom,.ty  then  being  .  forward  bending  of  the  head. 
Th«,  he  thm..s,  can  1«  avoiderl  by  tilting  the  desk  top  to  an  angle 
of  45  degrees,  a  suggestion  prol«bly  impossible  in  most  schools 
under  present  conditions,  but  the  shifting  of  the  writing  p.,«r  i, 
easy  of  adoption,  and  covers  the  most  serious  objection  to  the 
present  writing  position. 

•K  Jl'u  '"'*  '"'  ""  '^°""™«^"'"'  °f »  well-fitting  desk  is  so  Mmple 
that  there  seems  no  excu.se  for  neglecting  it. 

The  height  of  the  seat  from  the  floor  should  be  such  that  in 
sitting  the  feet  rest  easily  on  the  floor  or  on  a  foot-rest.     The  slope 
o   the  seat  should  be  bacicward  and  downward,  in  the  promrtion 
of  one  m  twelve,  the  depth  L-eing  a'-out  two-thirds  the  length  of 
the  thighs  and  the  width  that  of  the  buttocks.    Making  it  concave 
adds  to  the  comfort.    The  back  of  the  seat  should  have  a  slope 
backward  of  about  one  in  twelve  from  a  vertical  line,  and  the  back 
support  should  cc:ae  to  the  mid- 
dle of  the  shoulders  and  touch 
the  small  of  the  back.     The 
height  of  the  desk  should  be 
such  that  the  back  edge  allows 
fair  room  to  rest  the  fortarm 
naturally  with  the  elbow  at  the 
side,  and  the  slope  should  be 
about  one  to  six  forward  and 
upward,  the  edge   overlapping 
the  front  edge  o     the  seat  by 
about  one  inch.     The  desk  may 
well    be   made  adjustable  for 

distance  (Fig.  251,  a~b),  so  as  to  allow  freedom  in  getting  in  and 
out,  by  pushing  the  desk-lid  forward.  These  points  are  covered 
m  the  Garber  adjustable  desk,  described  in  the  chapter  on  Schools, 
but  no  matter  how  well  fitting  the  school  fumitim  may  be,  unless 
there  is  constant  change  allowed,  scoliosis  is  sure  to  develop  in 
some  growing  children. 


^f±^_ 


Fig.  ari._To  Khow  the  mcuurements 
requiird  n  determining  dcik  propcmions, 
a-h  is  thi  dUtance  which  is  here  miniu, 
becaiue  t  le  edge  of  the  d«k  overLp.  the 
front  of  the  wat. 


fi  >■ 


if 


M 

11 
to 


»9* 


i.xtMcmt:  IX  t.iiicATioN  AM)  ukdicim: 


ii 


INxir  liKhtin^  of  tlu-  >ihiMit  nN>m  i>  u  thinl  Hourcu  from  which 
scoliosis  Iw^ins.  If  the  |>u|iil  lunnot  sec  dearly,  he  Ininils  forward 
or  strews  his  l)ack,  and  the  same  elTect  is  prtxIu'X-d  if  he  sits  in 
his  own  liuht.  A  well-rlesi^ned  sch«)ol-rcK>m  should  have  windows 
placed  hi^h  enough  to  let  the  li^ht  fall  <>\er  the  left  shoulder,  and 
never  directly  from  in  front  or  behind. 

The  raisinji  of  om  side  of  the  seat  will  reverse  a  lie^inning 
curviture  (Fi^s.  atSand  .--.v^).  and  this  may  lie  used  as  an  auxiliary 
mean.i  of  treatment  by  plarint^  the  patient  uiKm  such  a  seat  from 
a  half  lo  one  hour  daily.  \\  i?ere  one  lej^  is  short,  the  f(xtt  should 
he  raisol  l)y  wearing  an  insole  of  cork  in  the  Ixwt;  antl  a  child 
who  h'lbitually  rests  with  the  weight  on  the  rij^ht  le^.  as  in  Fig. 
235,  should  be  trained  to  reverse  the  resting  |>osturc  l>y  using  his 
left  leg  as  the  habitual  base  of  sup]K)rt. 

The  main  corrective  treatment  of  scoliosis  must,  however,  be 
by  active  exercise  and  stretching,  and  the  muscles  must  be  de- 
veloped ami  trained  to  maintain  the  correct  jKislure  with  ease. 
Treatment  must  be  thorough  and  regular,  extending  from  half  tn 
one  hour  daily  for  six  months  at  least;  and  even  after  an  apparent 
cure  has  been  obtained,  the  patient  should  be  kept  under  close 
observation  for  at  least  two  years,  to  check  the  first  signs  of  rela])se. 

As  most  children  su*Tcring  from  scoliosis  are  below  the  normal 
in  strength  and  resistance,  it  is  essential  that  exercise  should  not 
be  pushed  beyond  the  |K>int  of  general  fatigue,  ami  the  greatest 
care  shoul<l  be  taken  to  limit  the  number  of  muscle  groups  exer- 
cised to  those  more  directly  affected,  so  that  the  resulting  fatigue 
may  be  Uxralized  to  them  and  not  spread  over  the  whole  muscular 
system,  for  most  of  the  discre<Iit  under  which  the  exercise  treat- 
ment of  scoliosis  has  lalwre^l  has  been  due  to  the  inaccuracy  of 
the  e   .-rcises. 

K\?ry  course  should  begin  with  what  is  known  as  '"straight 
work,"  such  as  is  described  for  round  shoulders,  in  which  the 
muscles  on  botli  sides  are  etjually  employed,  with  special  emphasis 
laid  upon  chest  develo[)ment,  but  in  a  few  weeks  one-sided 
movements  should  be  intro<luce<l  in  appropriate  cases,  such  as 
are  described  for  the  raising  of  the  right  shoulder,  and,  gradually, 


NIK    TRMTMtNT    OF    StC)L|„stS  jyj 

.trctchinK  movcmcn.,  ,h.,ul.l  1.  ,.u«h,,  lik.  >h,H.   picurol  in 

'.nn«  use,!,  an.    ,h.  ,urKc,.n  «ra,„in«  .he  K-f.  or  ri«l„  h.n.l    an,l 
s"  |.r.Kluc,n«  a  ., agonal  ..n.i..n  on  the  spin..     All  free  movement, 

S  ,7  T- '" l'" ''■■"'"■  '""'"■""■  "••"■'' '^ '"""■' "I--  - 

lallj  l)y  holilinj;  the  arm- 
«>  us  to  ^.ive  the  j;reale>l 
corrwiion  of  the  cur\aHire. 
This  may  Ijc  with  the  ri((hl 
arm  up  ami  the  left  arm 
out,  or  with  the  ri^ht  arm 
up  ami  the  left  arm  ilown, 


FiB.  JS>.— A  (irl  aunt  7  yran 
with  KVrre  uaacous  lateral  rurva- 
tun-  of  the  spinp,  in  the  "hahit- 
ual"  inalure  (Bernard  Roth). 


■  J53.— <;irl  aged  ;  years,  viith  severe  u- 
X-..U.  lateral  curvature  of  the  .pine,  when  |,la,i-J 
"■  'I-  "keynole"  [rature  (Bernard  Roth,. 


in  the  * 


or  With   both  arm.,   above  the  hea.l,  or  the  ri«ht  arm  ex.en.letl 
each  individual  case. 

In  applying  asymmetric  exercises  it  is  to  be  remembercl  that 
the  most  freely  movable  regions  of  the  spine  are  the  most  abun- 
dant y  provitied  with  muscles,  an,l  a  brief  analysis  of  their  action 
and  the  means  of  isolating  their  play  under  normal  conditions  will 


296 


EXESaSE  IN  EDUCAnON  AND   MEDICINE 


be  of  assistance  before  Uescribing  the  sjwcial  exercises  employed 
when  their  action  is  disturbed  by  scoliosis. 

In  the  lumbar  region  the  psoas  takes  its  origin  from  the  bodies 
of  all  the  lumbar  and  the  twelfth  dorsal  vertebrie,  passing  down- 
ward and  out  of  the  pelvis  to  be  inserted  into  the  small  tro- 
chanter of  the  femur  (Fig.  254).  The  femur  can  be  used  as  a 
lever  to  pull  on  the  bodies  of  the  vertebra  by  means  of  the 
psoas.  As  rot.  tion  of  the  lumbar  spine  takes  place  about  the 
articular  facets,  acting  as  a  pivot,  and  behind  the  origin  of  the 
psoas,  the  right  psoas  could  thus  be  made  to  pull  the  bodies  of 
the  lumbar  vertebra;  over  to  the  right,  and  would  tend  to  un- 
wind a  rotation  to  the  left.     The  problem   is  to  put  into  action 


<^^ 


IIjA     ^"'^ 


Fig.  354.— Direction  of  the  pull  of  the  jwoas  on  the  lumbar  spine. 

the  right  psoas  muscle  without  involving  too  many  additional 
muscle  groups.  If  we  flex  one  or  both  thighs,  the  abdominal 
muscles  do  most  of  the  work.  If,  however,  the  right  thigh  only 
be  flexed,  and  the  left  heel  pressed  backward  against  the  table, 
the  patient  being  recumbent,  the  abdominal  muscles  may  be 
relaxed,  and  a  comparative  isolation  of  the  right  psoas  obtained 
with  a  little  practice  (Fig.  255). 

The  intrinsic  muscles  of  the  back,  known  collectively  as  the 
erector  spinae  mass,  including  the  multifidus  and  other  short  deep 
slips,  are  most  complicated  in  their  distribution,  this  very  com- 
plexity being  useful  in  that  its  strands  may  be  employed  in  relays, 
the  tired  fibers  being  replaced  by  fresh  parts,  and  the  onset  of 
fatigue  accordingly  postponed. 


THE   TREATMENT   OF    SCOLIOSIS 


297 


As  a  mass  it  takes  its  origin  from  the  fjosterior  asi)ect  of  the 
sacrum,  from  the  iliac  crest,  the  lumbar  spines,  and  the  transverse 
processes.  It  is  very  thick  and  fleshy  in  the  lumbar  region,  where 
Us  two  mam  divisions  are  defined,  the  outer  tendons  going  to  the 
SIX  lower  nbs,  just  outside  their  angles,  and  prolonged  upward  by 
the  accessorius  and  the  cervicalis  ascendens,  the  inner  division 
more  thick  and  fleshy,  going  to  rib  and  transverse  process  through-' 
out  the  entire  dorsal  region,  with  an  additional  bundle  going  from 
the  second  lumbar  spine  to  the  first  dorsal  (Fig.  230)  The 
deeper  layers  of  this  inner  division  fill  the  hollow  between  the 
transverse  and  spinous  processes,  the  general  direction  being  for- 
ward and  inward,  while  in  the  lumbar  region  muscular  slips  go 


Fig.  i55._Raisi„g  right  fTOt  »rtth  weight  attached. 


between  adjacent   transverse  processes,  as  well  as  between   the 
spmes. 

The  general  action  of  this  muscular  mass  is  to  bend  the  spine 
like  a  bow-string  and  to  pull  down  the  ribs  on  the  active  side  at 
the  same  time  increasing  lordosis.  The  quadratus  lumborum  is 
a  depressor  of  the  last  rib,  and  acts  with  the  erector  spina,  of  the 
same  side. 

The  lumbar  and  lower  dorsal  portions  of  the  erector  spina;  are 
isolated  in  action  alternately  in  the  act  of  walking,  as  can  be 
readily  demonstrated  by  placing  the  hands  over  the  loins  and  feel- 
ing them  spring  into  action  at  each  step  (Fig.  259).  Support  of 
the  weight  on  the  right  leg  involves  a  contraction  of  the  left  lumbar 
erector  spinas.    Support  of  the  weight  on  the  right  arm  and  the 


II! 
■   i! 


2gS 


EXrSCISE  IN  EDUCATION  AND  MEDICINE 


feet,  as  in  the  diagram  (Fig.  257);  brings  into  action  the  right 
erector  spins,  but  if  the  support  be  at  the  hips,  the  action  is  re- 
versed except  in  the  cervical  region  (Fig.  256). 

In  the  dorsal  region  the  muscles  are  much  thinner,  more 
tendonous,  and  the  intertransversales  and  interspinales  degen- 
erate into  ligamentous  bands,  and  the  dorsal  spine  is  much  less 
directly  affected  by  muscular  action  than  either  the  lumbar  or 


Fig.  356. — Left  rrector  spins  in  action  <Uiring  support  at  liip. 

cervical,  but  the  ribs  can  be  employed  as  levers,  and  the  thoracic 
cage,  with  its  muscular  attachments,  can  be  made  an  active  means 
for  correcting  deviation  and  rotation. 

In  movements  where  the  humerus  is  fixed  and  the  spinoscapular 
muscles  contracted,  the  spinous  processes  are  pulled  over  to  the 
active  side  by  the  trapezius,  the  latissimus  dorsi,  and  the  rhom- 


Fig.  357. — Action  of  riglit  erector  apinc  in  doraal  crossing  to  left  side  during  support 
at  feet  and  shoulders. 

boids.     If  the  pectorals  of  the  opposite  side  be  contracted,  an 
additional  torsion  is  exerted  on  the  dorsal  spine. 

The  dorsal  region  can  be  reached  through  the  action  of  the 
respiratory  muscles.  The  upper  ribs  being  first  fixed  in  forced 
inspiration  by  the  scaleni,  serratus  posticus  superior,  and  the 
stemomastoid,  the  thorax  is  flexed  toward  the  side,  showing  the 
convexity,  forcing  out  the  walls  of  the  collapsed  side,  and  so 
lessening  the  rotation  of  the  ribs  and  deviation  of  the  spine. 


THE   TBtATMENT   OF   SCOLIOSQ 


»» 


In  the  cervical  region  the  erect  spine  is  extended  by  the  splenius 
capitis  and  colli,  by  the  complexus,  and  by  the  reappearance  of  the 
intertransversales  and  interspinales,  as  muscles  after  their  liga- 
mentous degeneration  along  the  dorsal  spine,  besides  the  obliques 


Fig.  958.— Erector  spina  in  action  during  Fig.  ijg.— Left  erector  spinie  in  action 

forward  bending.  during  support  on  right  leg  in  standing 

or  wallting. 

and  recti  of  the  suboccipital  triangle,  all  forming  the  thick,  fleshy 
mass  of  the  back  of  the  neck.  Movement  here  is  very  free  in 
all  directions,  most  notably  rotation  or  torsion,  which  takes  place 
largely  at  the  first  two  cervical  joints  through  the  action  of  the 


Fig.  360. — Torsion  of  thorax  by  muscular  action. 


inferior  obliques  and  the  more  superficial  muscles,  which  are  all 
directly  accessible  to  exercise. 

A  muscle  can  be  developed  only  by  active  contraction  and 
relaxation.    Continuous  tension  quickly  tires  and  lowers  its  tone, 


a 


,1O0  EXERCISE  IN   EDUCATION   AND   MEDICINE 

as  has  been  already  stated,  so  that  in  prescribing  exercise  it  is 
necessary  to  distinguish  between  those  given  for  the  purirose  of 
increasing  muscular  tissue  and  [jower,  which  should  be  compara- 
tively quick  and  frequently  repeated,  and  those  which  aim  at  the 
stretching  of  muscles  and  ligaments,  which  should  be  slow  and 
long  maintained. 

In  c  escribing  the  gymnastic  treatment  of  scoliosis  the  curves 
will  bi  considered  in  the  order  of  their  frequency,  and  without 
attempting  to  give  an  exhaustive  list  of  all  possible  exercises,  those 
that  are  described  will  be  arranged  in  the  form  of  prescrii)tlons 
for  typical  cases  and  illustrated  by  case  reports. 

.All  exercises  and  stretching  movem(!nts  should  be  given  daily, 
with  a  period  of  rest  after  three  or  four  movements;  they  should 
be  so  alternated  and  combined  that  no  two  employing  the  same 
muscles  in  the  same  way  shoulrl  follow  one  another  and  so  cause 
excessive  fatigue. 

The  most  frequent  deformity  is  a  total  left  scoliosis  or  C-shaped 
curve,  and  the  following  prescription  of  exercise  would  be  indicated : 
Exercise  /.— Patie"t  standing  in  the  correct  position,  hands 
at  the  side. 

Raise  the  right  arm  forward  and  upward;  inhale;  upward 
stretch;  rise  on  tip-toes  and  raise  the  left  foot  sideways;  upward 
stretch;  lower  the  arm  and  foot  to  the  standing  position. 

This  movement  will  develop  the  upper  part  of  the  trapezius, 
rhomboids,  and  deltoid  of  the  right  side,  raising  the  shoulder  and 
stretching  the  thorax.  .\l  the  same  time  the  uneven  support 
brings  into  strong  action  the  lower  part  of  the  left  erector  spina>. 
Exercise  //.—Position  standing,  fingers  interlocked  behind  the 
back. 

Movement:  Roll  the  shoulders  backward,  supinating  the  arms 
(Figs,  sio  and  211),  and  then  bend  the  body  to  the  left. 

This  exercise  stretches  all  the  anterior  muscles  and  ligaments 
of  the  shoulder-girdle,  improves  its  flexibility,  and  reverses  the 
curve. 

Exercise  ///.—Position  standing,  left  foot  forward  in  lunging 
position,  hands  on  hips. 


THE   TREATMENT   OF    SCOLIOSIS 


301 


Movements:  Raise  the  right  arm  sideways;  inhale;  upward 
stretch;  forward  bend  until  the  right  hand  touches  the  noor  in 
front  of  the  left  foot;  upward  stretch; 
exhale.  This  may  be  varied  by 
bending  from  the  standing  position 
and  raising  the  left  arm  (Fig.  262). 


Fig.  261. 


Fig.  363. 


This  movement,  besides  developing  the  upper  right  shoulder 
muscles,  improves  the  lung  power  by  filling  the  lungs  in  their 
most  favorable  position  and  compressing  the  air  in  the  downward 
bending  movement.  The  right  side  of  the  thorax  is  stretched 
during  the  forward  bending  movement,  and  the  left  latissimus 
dorsi  is  contracted  by  i)ressing  downward  on  the  left  hip  with  the 
left  hand. 

Kxerdse  /I'.— Patient  supine  on  the  plinth,  with  the  right 
knee  over  the  end,  the  left  arm  behind  the  back,  and  the  right  ha'nd 
grasped  by  the  surgeon. 

Movement:  Starting  with  the  elbow  at  the  side,  the  surgeon 
pulls  the  arm  up  slowly  sideways,  the  patient  resisting.     When 


303 


EXERCISE   IN   EDU(\TIO.N   AND  MEDICINE 


fully  extended  above  the  head,  the  surgeon  exerts  as  much  tension 
as  possible,  counting  five.  The  patient  then  draws  the  arm  down 
to  the  startmg  position,  the  surgeon  resisting. 


FiS-  363.— Stretching  of  rfgtit  side 


In  this  stretching  movement  the  two  points  at  which  the 
stretching  power  is  applied  are  the  right  hip  and  the  right  shoulder 
so  that  this  tension  will  reverse  the  curve  and  stretch  the  right 
Side  of  the  trunk.  * 


Fig.  364 


Each  of  these  exercises  should  be  repeated  at  least  twenty 
times,  and  should  be  followed  by  a  short  rest,  after  which  the 
following  should  be  given: 


ii!! 


THE    TREATMENT  OF   SCOLIOSIS  303 

Exercise  V.-Patient  lying  on  the  right  side  with   the  leu, 

.rh-r/ra?'  '^^  '^'^  ^-^  -—  "-^  ^-  -' ^ 

Movement:  Side  flexion  of  the  trunk  (Pig.  364) 
In  this  exercise  it  will  be  necessary  for  the  surgeon  to  assist 
most  pafents  at  first  and  to  urge  them  .0  bring  the  b^y  as  hig 
poss,ble.    The  entire  erector  spin.-  mass  on  the  left  side  is  — 
ully  employed,  and  the  effect  may  he  still  further  increaCby 
placmg  both  hands  behind  the  head  ncrease<l  by 

the  plinth,  right  arm  extended  upward. 


Fig.  a«s. 


andtjir'^  '^r^  "r^'""'  '°'"''^   "■"'«'"  "^  ^-ard 
and  the  left  arm  backward  (Fig.  265). 

Exercise  17/.— Patient  lying  supine 
_     Movement:    Raise    the  right  arm  forward,  upward  stretch 
inhaling  slowly;  lower  to  the  side,  exhaling  ' 

This  should  be  repeated  at  the  rate  of  twelve  to  the  minute 
r"  etittn""™"""  "■""""'  °'  "'"''  ''^^"'''^"  --«<  ^'  -h 

Mo^men^'' T~f '""'  '^'"^  "'""''  ""= '''''  '«"  ""'-^  '-«-«!• 
asinFt  ^;""tu™™''°"  "•'■"'  "-^  --^^t  of  swimming, 

as  m  F,gs.  .14-216.    This  should  begin  by  repeating  the  swimming 


iHl 


3<H 


KXERCISE   IN    EDtfCATtON    AND   UEDICINE 


4 


movement  five  times,  folloned  by  a  rest.  Gradually  patients  will 
be  able  to  go  up  to  twenty  or  thirty  times  withoui  resting. 

These  exercises  should  be  followed  by  a  rest. 

Exercise  /.Y.— Suspension,  with  lateral  traction.  The  patient 
puts  the  head  in  a  Sayrc  sling  and  grasps  the  cord  prefiaratory 
to  self-suspension.    A  band  of  webbing  is  placed  about  the  point 


Fig.  366, — Self  suspension  with  pnuure  on  the  left  side  to  correct  rotation. 

of  the  greatest  deviation  on  the  left  side,  usually  about  the  tenth 
dorsal  (Fig.  266). 

Movement:  The  patient,  pulling  on  the  cord,  raises  herself 
from  the  ground,  while  the  surgeon,  by  means  of  a  cord  and  pulley, 
draws  her  sideways,  stretching  the  right  side.     Repeat  ten  times. 

This  should  be  followed  by  a  rest. 

Exercise  A'.— Right  hand  on  the  back  of  the  head,  left  hand 
on  the  hip. 

Movement:  Side-bending  to  the  left. 


THE   TMEATMENT   Of   SCOLIOSIS 


305 


The  treatment  should  end  by  deep,  firm  stroking  from  above 
downwar.1,  about  ten  or  twelve  times  on  each  side,  using  one  hand 
to  press  upon  the  other. 

The  follo\ying  is  a  typical  case  re|»rt: 
V.  O.,  aged  twenty-one.  Consulted 
me  April  aoth.  .At  the  age  of  eight 
years  she  fell  down  stairs,  and  was  con- 
fined to  bed  for  three  months.  She 
states  that  since  then  she  has  been  suf- 
fering from  pains  in  the  back  at  the 
point  of  the  right  scapula,  burning  or 
boring  in  character,  much  worse  after 
sitting  still  for  any  length  of  time.  Has 
been  unable  to  attend  school  or  do  any 
work  on  account  of  pain  and  fatigue. 

Examination.  —  111  nourished  and 
anemic;  flat  chest;  prominent  abdomen; 
projecting  chin;  round  shoulders.  Right 
scapula  one  and  one-half  inches  lower 
than  the  left  (Fig.  j68).  Total  left 
scoliosis,  with  deviation  greatest  about 
the  ninth  dorsal.  Rotation  slight,  flexi- 
bility good,  the  iliac  crests  even  in  height.  ^^'  '"• 
Patient  winces  on  pressure  over  the  point  of  the  left  scapula  and  left 
lumbar  region. 


'   vo      '  »riiiin-v  I  V 


•v,i..llt 


Fig.  .68.-Tmci,w  uk.n  a.  the  beginning  „d  .fl„  one  mon.h'.  t™a,me„t  by  m, 
and  exercise  only. 

ft-escription  of  exercises  such  as  described,  with  one  hour's 
rest  daily,  recumbent,  in  the  afternoon. 


li  J 1 


pi 


306 


EXEICME   IN   EDl'CAnON   AND  liEDIClNE 


May  j8th:  She  has  been  at  work  daily  (or  one  month.  Right 
shoulder  still  lower,  but  the  improvement  very  marked  and  the 
spme  almost  straight  (Fig.  ,68).  Occasional  pains,  not  constant 
m  location  or  duration,  probably  hysterical  in  character.  General 
condition  much  improved.  To  continue  daily  work  at  home  /or 
one  month. 


FIj.  170. 


June  30th:  Improvement  retained.  Can  attend  to  social 
duties  without  any  discomfort.  The  salutary  effect  of  the  exer- 
cises on  the  general  condition  of  this  young  woman  was  most 
marked. 

In  a  right  dorsal  and  left  lumbar  curvature  (Fig.  246)  the 
following  prescription  would  be  applicable: 

Exercise  /.—Position  standing,  hands  on  the  hips. 

Movement:  Raise  the  left  arm  and  left  leg  sideways;  inhale 
and  upward  stretch;  sideways  lower;  exhale  (Fig.  269). 


THE   TtEAniENT  or  iCOUOBM 

In  this  the  left  »i,lc  of  the  ihoraT   «.l,i-.k  ■ 

rotation  of  the  ribs  on  the  Ih,    ! -.'m      ^  '"  ™"""'"'  ''^  "'^' 

lumbar  cune  will  .«  „ver  J|  b '  .  e  nr   f""''  '"''  "■^'  ''■" 

contraction  of  the  left  er^^sl^  '  '"•'"«  '"  '^^  '*'^»  ""'I  'he 

Ro"ingof,he,houldersn  ''■"''''   ""^  '■"'«^'"  '"'"'^''e.l 

-.  -a^oJ!'2i;:i;ttS^i'-'e-'>endin«  is  accompanie.1 
thi»  exerci^  ui),  have  I  ,  effcxTon  th  ^f  """'  """'^•.  »  "-at 
vertebr.beinK  locked  inllZ^::':,^;^:  '""'^  ""^ '"-"" 


Fig.  .r 


Exercise  ///.-Pati.  ,t  standing,  hands  at  the  sides 

on  :i:eT"K J::r,el:"  '^^  ""  '-"-^^  "•«"•  nana 
touching . I  flo^rriLeltak^TT'  '"'""^'  f"™""  '^"d, 
(Fig.  .70.  '       "''■  """*=  '"'^'' '"  'he  standing  position 

left  heel,  hand,  on  the  hips  '^"''""^  ^^  *''"'    "" 


if  *■? 


Jo8 


eXElnSE   IN    KIX-CATKIN   AND   MKniCINE 


The  tension  on  the  right  foot  should  Iw  incrca.sc<l  hy  placing 
>hot -bags  across  the  ankle,  starting  with  a  weight  of  five  |iounils, 
aiul  increasing  it  to  ten  or  fifteen  as  the  strength  allows  (Fig.  155, 
p.  397).  The  iMtient  should  Ijc  carefully  instructed  to  relax  the 
alxlominal  muscles  so  that  the  strain  may  fall  u|H)n  the  right 
psoas,  which  will  pull  the  limlies  of  the  lumlwr  vcrtebrii-  over  to 
the  right  and  so  unwind  a  lumbar  mtulion  In  the  left. 

Exercise  V.— Patient  jrone,  the  right  foot  fixed,  the  left  arm 
up,  and  the  right  arm  down. 

Movement ;  Trunk  extension,  with  the  stretching  of  the  right 
arm  backward  and  the  left  arm  forwdrd  (Fig.  373). 


i!.  1 


fit-  til- 
Exercise  VI. — Patient  supine,  right  knee  over  the  end,  as  in  Fig. 
363,  but  right  arm  behind  the  back,  left  arm  ."^rasped  by  the  surginm. 
Movement;  The  left  arm  is  pulled  upward  and  strong  tension 
is  put  upon  it  by  the  surgeon.  The  patient  then  pulls  the  arm 
forward  and  downward,  the  surgeon  resisting.  In  this  way  the 
rotation  is  unwound  by  the  diagonal  tension  running  from  the 
right  hip  to  the  left  shoulder,  reversing  th<'  curves. 

Exercise  17/.— Patient  lying  on  the  n^ht  side,  as  in  Fig.  264, 
but  the  right  hand  on  (he  hip,  the  left  hand  behind  the  head. 
Movement :  Side  flexion  to  the  left. 

This  exercise  is  aimed  at  the  lumbar  curve,  which  will  be 
reversed  by  the  side-bending  to  the  left  in  the  extended  position  of 
the  spine,  essentially  a  motion  of  the  lumbar  region,  the  bodies  of 
the  venebne  tummg  toward  the  concavity  of  the  curve. 


V 

\i   I 


THE  TIEATHENT  OF  KOUOUI  ^g^ 

£»-r,f»,  I7//,-Patif„t  fccuml^nt,  ,upine. 
R..,c  the  Icf,  arm  ami  ,he  rl^h, !.«;  inhal,.;  lower;  slowly  „hal. 
Thisshoul.ll«..f„||„we.ll,ytt.,hortrcsi.  Xi»naK. 

Exffciu  /.V.-.Su«|*n.sion  hy  the  Sayrc  sling. 
Movement:  Si,le  .rac.lon,  prepare   M„^    ,Le,l  on  ,hc  left 
lumbar  region.     Re,,ca.  from  ten  to  twenty  limes 

(FiK  !.'))"'  ■^'■~  ^'""  '"'"'"'  ""'  •"■""■  »'■''•=  «'*'™  "'  'he  rlKh, 

In  a  left  dorsal  an,l  rixh.  lumbar  curve  (Fi^.  ,75)  practicallv 
.he  »me  exerc  sc-s  may  l«  u«,l.  except  tha.  ,n  e   -r^  cat  ,h 
opiK>s,te  IcK  an.l  arm  are  employe,!. 


f'W-  ifj-l-'our  Itadnuj   iilu.Craling  the 


V 


S 


C.  C,  aged  thirteen.    Consulted  mc  January  27,  ,806 

nght  lumbar  curvets  with  rotation,  round  shoulder,    flat  'h  " 
pro.rud,„g  aUlomen  and  chin,  and  general  re.rSofll^ 

General  health  has  not  been  very  L-mxi      T^.„     •  .        ... 
already  been  treated  for  spinal  cur^Turt  "''"'  '"' 

The  indjcations  here  would  be  to  dcvpUr,  .i,„ 


1* 


ml 


3IO 


EXERCISE  IN   EDUCATION   AND   UEDICINE 


After  daily  treatment,  lasting  over  two  months,  the  second 
tracing  was  obtained,   the  lumbar  cur\ature  being  practically 


Fig.  374. — Movement  for  left  dorsal  and  right  luml>ar  curve. 

corrected,  although  there  was  still  a  dorsal  curvature  with  the 
right  scapula  low. 

She  reported  twice  a  week  for  two  months,  taking  a  modified 
daily  prescription  at  home.    She  then  left  the  city  for  the  summer, 


~l    \V 


\^ 


Fiy.  375.— Couree  of  triple  curve  under  treatment:  Lefl  lumbar,  right  dorsal,   and   left 
cervical. 

and  the  following  October  a  third  tracing  was  taken,  showing  that 
the  improvement  was  retained.  During  that  winter  she  reported 
once  a  week  and  continued  her  exercise  at  home. 


THE    TREATMENT   OF   SCOLIOSIS 


3" 


^0  a^ 


■(   ) 


'•|»4f. 


*^       -^^^-'M*. 


Three  years  later  a  fourth  tracing  was  taken,  showing  that  the 
correct  position  had  been  maintained. 

It  will  be  noticed  from  the  tracing  that  the  jjatient  has  developed 
from  a  child  of  thirteen  to  a  young  woman  of  sixteen  (Fig.  275). 

Cunes  due  to  infantile  paralysis  will  require  long-continued 
treatment,  esiwcially  where  they  are  severe  and  structural 
localized  and  fixed.  In  some  of  these  ca.ses  the  best  that  can 
be  hoped  for  from  gymnastics 
is  to  develop  the  general  mus- 
cular system,  and  to  form  com- 
pensating curves  above  and 
below  the  primary  curve,  thus 
giving  a  general  appearance 
of  symmetry  to  the  outline  of 
the  back. 

S.  M.,  aged  nine  years.  Consulted  me  in  September.  Six 
years  ago  he  had  left  hemiplegia  lasting  six  months,  which, 
to  all  appearances,  graduahy  passed  away.  .About  two  years 
ago  he  noticed  while  walking  that  the  left  shoulder  protruded 
(Fig.  276,  i).. 

Examination  showed  a  left  lateral  curvature  high  in  the 
dorsal  region.  Marked  rotation,  some  pain  over  the  convexity, 
and  diminished  flexibility.  Slight  compensating  curves  in  the 
lower  dorsal  and  lumbar  region  were  present. 

After  two  months  of  daily  exercise  and  stretching,  a  second 
tracing  was  taken,  showing  the  development  of  the  compensating 
curve  and  the  lowering  and  partial  replacing  of  the  left  scapula. 
The  improvement  continued  from  September  until  March,  when 
a  third  tracing  was  taken,  .showing  a  lowering  of  the  scapula  at  the 
expense  of  an  increase  of  the  lumbar  curve  (Fig.  276,  2).  This 
was  the  extent  of  the  improvement  obtained,  but  t'le  general 
api)earance  of  the  back,  especially  when  dressed,  was  very  much 
better,  and  the  muscular  development  and  general  efficiency 
greatly  improved. 

Where  the  curvature  is  due  to  inequality  of  the  extremities, 
as  in  the  tracing,  this  must  be  corrected  by  raising  the  heel  of  the 


3" 


EXERCISE  IN  EDUCAnO;'.   AND  MEDICINE 


/., 


Fig. 


shortened  side,  which  is  sometimes  all  that  is  necessary  (Figs. 
232  and  233,  p.  276,  and  Fig.  247,  p.  289). 

One  of  the  most  important  points  in  the  treatment  of  all  these 
cases  is  the  development  of  the  thorax,  and  it  is  remarkable  how- 
much  improve.nent  can  be  obtained  in  this  direction  by  respiratory 
and  stretching  exercises. 

I  'ne  case,  S.  R.,  aged  -^^ighteen  years,  came  with  persistent 
wearing  pain  in  the  back,  round  shoulders,  and  lateral  curvature. 
There  was  a  strong  family  history  of  tuberculosis. 

On  October  7th  her  lung 
capadity,  tested  by  the  spiro- 
meter, showed  80  cubic  inches. 
November  28th,  after  a 
little  over  one  month  of  steady 
work,  it  was  no,  and  on  Janu- 
ary 3d,  125.  The  pains  in  the 
back  had  disappeared,  the  cur- 
vature was  corrected,  and  her 
general  health  excellent  (Fig. 
277). 
Here  was  an  increase  in  lung  capacity  of  45  cubic  inches  in 
three  months.  While  such  a  result  is  unusual,  still,  after  going 
over  thirty  consecutive  cases,  I  find  an  average  gain  of  21  cubic 
inches,  and  among  these  were  several  that  have  increased  from 
30  to  35  cubic  inches  in  less  than  three  months  by  daily  work. 

In  structural  cases,  where  the  treatment  by  gymnastics  and 
posture  is  insufficient,  stretching  and  retaining  apparatus  are 
necessary. 

.Among  the  simplest  is  the  following  (Figs.  278  and  279) : 
"  The  patient  lies  face  downward,  with  the  knees  flexed,  on  a 
board  three  feet  wide  and  four  feet  long.  .Assuming  the  case  to 
be  a  right  dorsal  curve,  a  broad  canvas  strap  is  passed  around  the 
left  upper  thorax,  over  and  under  the  patient,  and  fastened  to  a 
cleat  on  the  right  side  of  the  board.  This  furnishes  a  point  of 
resistance  against  the  left  side  of  the  upper  thorax  at  the  level  of 
the  axilla.    A  broad  canvas  strap  is  then  passed  aroimd  the  left 


—Tracings  at  the  beginning 
and  alter  three  months  of  daily  treatment 
for  chest  expansion  and  curvature. 


THE    TREATMENT   OF   SCOLIOSIS  313 

Side  Of  the  pelvis,  above  and  below,  and  is  fastened  to  a  cleat  on 
the  r,ght  s.de  of  .he  board.  This  furnishes  a  point  of  pr^ure 
agamst  the  left  side  a,  the  level  of  the  pelvis.    1  broad'ZI 


Fig.  .,8.-Slr«<:hi„g  b<»rd  with  loop.,  „ady  for  appli 


lotion  toafc/zdoraal  curve  (Lovett). 


Strap  is  then  placed  around  the  thorax  on  the  right  side  at  the  level 
of  the  greatest  po.nt  of  the  curve.    Its  upper  end  is  fastened  to  a 


n...„.-s.„tcKi„g  bo.^  ,i,t  loops,  ^,^,^,„ ,  ^,,  „,;..  ^        ^^ 

(Lovett). 

cleat  at  the  left  side  of  the  board;  its  lower  end,  passing  beneath 
at  the  left  side  of  the  board.    By  means  of  this  pulley  any  reason- 


i.'! 


ir 


i  II 


^^1! 


I '  I 


314 


EXERCISE   IN   EDUCATION   AND   UEDICINE 


able  degi'ee  of  force  may  be  exerted  against  the  right  side  of  the 
thorax,  pulling  it  to  the  left  and  at  the  same  time  reducing  the 
rotation,  because  its  upper  end  is  fastened,  its  lower  end  moving 
toward  the  pulley.  The  efficiency  of  this  apparatus  is  greater 
than  the  same  movement  done  during  suspension,  because  stretch- 
ing is  done  more  easily  when  the  spinal  muscles  are  relaxed. 
Patients  should  be  stretched  up  to  the  point  of  mild  discomfort 
daily,  and  kept  in  the  corrected  position  for  fifteen  or  twenty 
minutes. 

The  application  of  apparatus  in  severe  cases  for  retaining  the 
improvement  obtained  by  gymnastics  and  stretching  need  not  be 


^ 


Fig.  aSo. — Course  of  triple  curve  under  treatment  by  exercise  and  stretching  only. 

taken  up  here  in  detail.  The  steel  brace  and  the  plaster  jacket 
both  have  their  advocates,  but  they  should  be  applied  only  to 
retain  the  child  in  the  best  possible  position  during  the  growing 
period,  and  dll  apparatus  should  be  easily  removable,  so  as  to 
permit  of  daily  exercises,  which  should  be  persisted  in  for  months 
or  even  years  if  one  is  to  expect  a  permanent  result. 

Improvement  or  qure  should  not  be  considered  permanent 
until  the  correct  T>osition  is  maintained  without  apparatus  from 
month  to  month,  as  shown  by  repeated  records. 


CHAPTER   XIX 

°^*^^  ATHIETICS  AS  A  FACTOR  IN 
DISEASES  OF  THE  CIRCULATION 

_  To  exercise  has  been  assigned  the  rflle  of  cause,  as  well  as  cure 
m  most  of  the  disorders  peculiar  to  the  circulatory  system. 

The  heart  is  a  muscle  capable  of  development  and  liable  to 
overwork,  and  the  arterial  system  shares  intimately  in  changes 
takmg  place  in  the  centra!  organ  of  the  circulation. 

The  heart  may  suffer  from— 

1.  Acute  or  chronic  overstrain,  characterized  bv  dilatation 
hypertrophy,  and  leakage  at  the  valves. 

2.  The  accumulation  of  fat  in  the  walls  or  in  the  pericardium. 

3.  A  slow  hardening  and  degeneration  of  the  heart  wall  and 
a  les.sening  resiliency  of  the  arteries,  « Ith  increased  blood-pressure 
known  as  arterial  sclerosis,  in  the  production  of  which  prolonged 
muscular  overstrain  has  been  given  an  im,»rtant  place  by  some 
authors. 

4-  Anginal  attacks,  accompanying  dilatation  and  caused  by 
bodily  or  mental  overexertion,  frequently  associated  with  arterio- 
sclerosis. 

5-  Actual  distortion  of  the  vahes,  due  to  inflammatory  action 
accompanying  acute  rheumatism,  chorea,  and  certain  other  acute 
diseases. 

In  the  fifth  class  the  valves  may  become  crumptel  and  the 
orifice  reduced  in  size,  iusing  stenosis,  or  the  flaps  may  fail  to 
meet,  the  blood-stream  leaking  back  when  the  contraction  is  over- 
sometimes  both  conditions  may  exist  in  the  one  valve. 

In  the  order  of  their  seriousness  valvular  defects  may  be 
classified  as:  First  and  least  dangerous,  stenosis  of  the  aortic 
valve  (Fig.  281),  overcome  by  a  compensating  thickening  of  the 

3>5 


I       (.'' 


3l6  EXERCISE  IN  EDUCATION  AND  HEOICIKK 

left  ventricular  wall;  second,  mitral  insufficiency  (Fig.  383),  the 


s       D         s       D         s        D        s 

FJR.  3X1.  —Endocardial  heart-tnurniur.     Stenosis  of  the  aorta.     A  ayitolic  murmur  ia 
the  ri^ht  second  intercMtal  apace  (Vierordt  and  Stuart). 

bltxxl  regurgitating  into  tiie  right  ventricle  through  an  imperfect 
closure  of  the  valve  between  it  and  the  lesser  circulation  in  the 


s        D         s        D         s        D        S 

Fig.  382.— j:ndocardial  heart-murmur.     Mitral  insufficiency.    A  systolic  murmui  at 
the  apex  of  the  heart  (Vierordt  and  Stuart). 

lungs;  third,  stenosis,  or  narrowing  of  the  mitral  vaKe  (Fig.  283), 
followed  by  an  increase  in  wall  thickness  and  dangerous  dilata- 


s        D        s        D        s        D         s 

Fig.  383. — Endocardial  heart-murmur.      Mitral  stenosis.     A   diastolic  r 
the  apex,  the  first  sound  valvular  or  appro.ximately  so,  if  the  second  sound  is  heard  at 
all  {Vierordt  and  Stuart). 

tion  of  the  right  ventricle;  and   last,    insufficiency  of  the  aortic 
valves    (Fig.   284).   which    throws  such  an   increased  burden  on 


s        D        s        D         s        D        s 

Fig.  384.— Endocardial  heart-murmur,  .\ortic  insufficiency.  A  diastolic  murmur 
at  right  seccnd  intercortal  space  or,  lietter,  lower  down  to  the  left  of  this  over  the 
sternum  (Vierordt  and  Stuart). 

the   left   ventricle   that   any  overstrain   is   liable  to  be   suddenly 
fatal.    This  last  condition  is  the  usual  consequence  of  the  Arst, 


ATHIETICS   AS    FACTOR    IN    DISEASES   OF   THE  CIRCILATION     yj 

since  the  hyiwrtrophy  resulting  from  aortic  stenosis  soon  sivt-s 
place  to  dilatation  of  the  aortic  orifice  and  consequent  regurgita- 
tion of  blood  into  the  left  ventricle. 

In  the  iihysiology  of  exercise  it  was  explaineil  that  bv  exercises 
of  effort  the  blood-|)re5surc  was  suddenly  raiseil  to  nearly 
double  the  normal,  falling  quickly  to  its  normal  level  with  the 
cessation  of  the  action  (McCurdy). 

In  the  ex|>eriments  of   Bowen,'    on  exercises  of  speed  and 
endurance,  the  rise  of  the  blood-pressure  followed    the   rise   of 
pulse-rate,  gradually  declining  until   the  end   of  the  test,  when 
it    fell    to    subnormal    and    slowly    recovered.      .\ccomi)anving 
tests  of  either  effort  or  endurance,  there  is  always  a  temimrary 
dilatation  of  the  heart,  which  must  not  be   looked  u]x,n  as  an 
evil.     The  heart  tends  to  dilate,  a.s  pointed  out  by  Roy  and  .\dami, 
as  a  matter  of  economy,  vhenever  its  work  is  incrt-ased.      This 
economy  results,  first,  from  the  fact  that  any  muscle  works  at  an 
advantage  when  somewhat  elongated,  and,  second,  because  the 
volume  of  the  spherical  mass  changes  faster  than  its  surface.     From 
this  It  is  clear  that,  as  the  heart  dilates,  the  volume  of  blood  pum|«d 
out  by  each  contraction  of  the  heart  muscle  increases  faster  than 
the  stretching  of  its  walls,  whose  inherent  elasticity  also  tends  to 
preserve  their  integrity.     It  is  only  when  the  dilatation  becomes 
excessive  and  is  accompanied  by  greatly  increased  blood-pressure 
that  harm  results.    This  dilatation  of  the  heart,  due  to  the  neces- 
sity of  increased  muscular  action,  is  physiologic,  and  it  is  only 
when  other  symptoms  are  present  that  the  heart  is  really  over- 
strained.   The  difference  between  one  acute  overstrain  and  the 
continuous  overtaxing  of  the  circulatory  apparatus  must  also  be 
borne  in  mini],  as  the  second  condition  can  only  l>e  the  result  of 
the  accumulation  of  repeated  single  overstrainings. 

The  investigations  of  Theodore  Schott  arc  jwrtinent  to  this 
question.  He  selected  wrestling  as  his  exerci.se-an  exercise  of 
effort  in  which  the  entire  muscular  system  takes  part,  but  which 
combines  endurance  if  carried  on  for  any  length  of  time.  The 
results  on  the  heart  action  are  shown  in  the  six  pulse-tracings. 

*".\mer.  Jour.  Phvs.,"  vol.  xi,  Xo.  r. 


ii- 


illi 


3i8 


EXEKCISE   IN   EDUCATION   AND   MEDICINE 


The  dilatation  of  the  heart,  both  to  right  and  to  left,  was  from 
one  to  two  centimeters  or  more.  With  the  advent  of  cyanosis 
he  also  discovered  a  great  lowering  of  the  blood-pressure.  He 
affirms  that  all  symptoms  gradually  disappear  in  a  healthy  man, 
and  that  the  severest  exercise,  even  if  accompanied  by  compression 
of  the  abdomen   by   means   of  a   belt,    has   but   a   temporary 


J^J^AKJ^J^^N^ytKSsM^  l^sh^ 


/ 


I 


Fig.  j8s.-a,  4  :3j  p.  u.  Before  wrralHng.  J,  4  145  p.  «.  Atlcr  ihrtc  round,  of 
wverc  wrestling.  .,  4  :5s  P.  m.  Conlinued  wrestling.  J,  4  :56  P.  u.  Renewed  wtest- 
Img.  e.  s  :"  P-  «•  After  severe  wrestling  with  tightened  bell.  /,  ,-.4,  p.  u.  Alter 
twenty  minutes'  rest,  showing  approach  lo  normal  action  (^chott). 

effect,  and  he  concludes  that  all  symptoms  of  heart  insufficiency 
disappear  in  a  few  minutes,  and  that  acute  overstraining  of  the 
heart,  when  it  does  occur  in  healthy  individuals,  tends  to  disappear 
readily  and  naturally,  the  time  required  depending  on  the  elas- 
ticity of  the  tissues.  With  older  persons,  when  the  heart-walls 
have  lost  a  considerable  part  of  their  elasticity  and  the  arterial 


fi; 


ATHLETICS  AS   rACTO,  «  DMEASES  O,  THE  CUCULATION     3,9 

wf-houriXr""'  ""  '■'  f"""""  "'™"«''  "^  ™-«  "f  'raining 
«.Ihout  further  symptom.,  or  bad  results.  Darling  remri,  » 
s.m,lar  case  in  an  oarsman  on  the  Har^■ar,l  crew     T,™  hiT,  tl 

neay  strain  may  cause  an  acute  dilatation,  especially  if  accom 
panied  by  great  mental  exci.-ment 

One  case  reported  by  Stengel  was  that  of  a  young  man  sound 

day  or  t«o  of  the  mjury.  In  the  course  of  a  very  tryinir  foot  ball 
^me  physically  and  mentally,  he  collapsed  7ud7enTy.  VVh  1 
seen,  he  was  bleedmg  at  the  nose,  cyanosed,  with  weak  flutteHn^ 

Lt'wt;"  t: "'  "^  "^f  ^"^'«^-Hr..folrt  ts 

conLr  f/  K  rf  """P"''"'^  P^'^'™'"''  *"d  '"'•  not  gain 
^tter  and  7  ^™''"  ''°'"'-     "^  "'-  ''«'""«  rapid  y 

better,  and  m  a  few  days  seemed  quite  well.    .After  ten  days'  res^ 

consequences.    He  has  engaged  in  athletics  more  or  less  activelv 

This  s  the  most  severe  case  of  dilatation  of  which  I  have  any 
personal  knowledge,  although  frequently  I  have  found  a  dilution 

"The  dilatation  is,  I  think,  concerned  in  second  wind.    The 


i  \ 


n 


■til! 


3«» 


EXERCmt:   IN    KtlUCATION   AND  MEDICINE 


f 


healthy  heart  increase!)  its  output,  the  luni{s  expand,  rcsisUnce 
falls,  the  riKht  icntriclc  pulls  itself  tof{ethcr,  and  second  wind  is 
established.  This  process,  trying  enough  to  an  unsound  or  defec- 
tive heart  or  to  elderly  men,  is  perhajw  never  injurious  to  the 
healthy  heart  in  young  adults.  I  have  many  times  seen  under- 
graduates and  others  look  ghasdy  at  the  end  of  a  long  spurt  of 
exercises,  but  never  saw  a  sounri  young  man  the  worse  for  tem- 
porary distress  of  this  kind.  If,  as  in  a  few  cases  that  I  have  seen 
again  and  again  in  growing  youths,  dilatation  of  the  heart  occurs 
leadmg  to  cyanosis,  the  attending  confusion  or  vertigo  is  generally 
sufficient  of  itself  to  stop  the  exercise  ii)  time." 

With  the  statement  I  can  most  cordially  agree,  and  if  |)tr- 
mancnt  or  rapidly  fatal  injury  ever  occurs,  it  must  lie  in  the 
notoriously  unfit  or  in  those  whose  age  should  have  led  them  to 
choose  more  sober  pursuits. 

The  presence  of  a  murmur  without  other  symptoms  is  so 
common  as  to  be  almost  habitual  in  the  young.  It  is  most  fre- 
quently found  over  the  pulmonary  valves,  but  when  at  the  apex, 
is  not  necessarily  due  to  mitral  regurgitation.  The  marked 
acceleration  of  the  onset  of  fatigue  and  the  slow  recovery  in  the 
untrained  or  the  overtrained  man  is  familiar  to  all  who  have  seen 
»uch  cases  after  violent  and  prolonged  exertion,  but  the  ultimate 
recovery  of  the  sound  heart  from  such  exertion  may  be  said  to  be 
universal. 

Blake  and  Larabee.  in  their  observations  on  long-distance 
runners,  averaging  about  twenty  years  of  age  and  covering  three 
Marathon  races  of  24  miles  each,  write : 

"So  far  as  observed,  no  ])ermanent  injury  of  any  kind  has 
resulted  from  any  participation  in  these  races." 

Simple  or  single  overstrain  and  acute  dilatation  of  the  heart 
may  ther  e  said  to  have  no  immediate  after-effects  on  the  healthy 
young  adult;  The  remote  after-effects  of  strenuous  exercise  has 
also  been  studied  by  Morgan  and  Meylan,  the  material  for  their 
observations  being  university  oarsmen,  members  of  the  university 
crews  of  Oxford,  Cambridge,  and  Har\ard.  A  crew  man  is  required 
to  row  repeatedly  a  distance  of  four  miles  at  top  speed,  the  posture 


;i 


ATHLKTXS    AS    FACTOR    ,s    ...SKASKS   „r   THK   CIRCLATION     J„ 

Of  ro«.i„«  lH,.ing  such  a,  ,o  im|,c,le  Ihf  full  frcclom  of  the  lun«,  an.l 
h ;  hear,  s  aeon,  whil.  ,he  movement  i,  „,  such  intensity  JZ, 
::;;:,  "'^f^''  "^  -  '-<-'  — ^  '-m  the  resulting.  J.: 

In  his  l..,k,  calk-l    ■l-niversity  r)ars."  K.  H.  M„r«an  look 
ami  C  aml>r„lKe,  from  .8,c^6,;,  as  his  lUI.I,  ami  in  his  investigation 

Of  t  esc,  ;  ether  s,..ak  of  themsc-lves  as  probably  injurctl.  „r  ve 

L:sr '■'■ '''"^  ^^•'''''•'■'^"' --'™- "■■•''■ -^^^^^^^^^^^ 

On  tabulating  the  crews  with  reference  to  ex,«ctation  of  life 

hn   e„m,«re,l   with   Dr.  Farr's   Knglish   Life   Tables,   which 

Ja  es  the  exix-ctation  of  a  man  of  t^.enty  at  forty  years,  he  found 

o   th    r'a^'TT  "'  ""  "^""  """"■'"«  '"^  "™-'  «-'ati 

Of  th7,  'h  It  ■'i'"'™"'  ""^  '""^■'«"  >■--  '•"»'«"  "f  forty. 
O  the  39  deaths,  he  found  that  , ,  dinl  of  fever,  ;  of  consumption 
from  other  forms  of  chest  .li.sease,  6  from  accident,  3  from  hean 
<l.sease,  r  from  Bn>hfs  disease,  and  S  fron.  various  caul  „o 
connected   with   athletics.     Of  the   7   dvinL-   fmn,   .r,n 

The,    show  about   the  average  mortality  from  diseases  of  the 
rt  7  T'T  ",  """  "  """"  »-""P"-on,  asdi.,close.l 

that Lr r  r"\"'"^'' ""' " '""^' •^-^ -"><=""--' 

that  they  rowe,!  without  preliminary  meji,al  examination.    There 
were  no  sudden  deaths  nor  rapi.lly  fatal  heart  cases 

In  America  a  similar  but  much  more  complete  set  of  observa- 
tions were  taken  on  Harvard  oarsmen  by  Dr.  G»rge  L.  Meylan, 
of  Co  umb,a  who  interviewed  every  survi>or  ..ersonally  whe^: 
P-..ble,  or  had  the  re,x,rts  made  out  by  their  mllical  attendant^ 
He  foun.'  that  15.  men  had  rowed  from  ,85.-9.  "f  whom  i 
sfll  su.,ved  (November  r.  rpo.),  thus  allowi,;^  eleve    y^r 

tZf"n       T  ^^^-^f -"^  '"  Sfve  time  for  any  evifeffec.s 
to  show.    He  mtemewcd  76  men  personally,  and  sent  to  all  a 

91 


3*» 


KXEICIHE  IN  EOUCAnON   AND  UtDIClNt 


questionnaire  tlwt  was  m«t  aclmirablc  in  its  compleleneii.  In 
lonfievity,  the  first  crew  (iSti)  showed  an  incr^se  of  1.6  years  |jer 
man  com|>arc<l  with  the  sciectcil  lives  of  the  insurante  tobies,  in 
which  a  man  of  twenty  has  an  expectation  of  43.3  years.  His 
results  were  inlerfere<l  with  by  a  numlier  of  death .  of  men  in  their 
prime  durinn  the  Civil  War.  By  allowinn,  for  those  killed  in 
battle,  the  or<linary  life  cx|iectation  of  men  of  their  anc,  the  advan- 
taRc  '> .  luld  Iw  increased  to  5. jq  years  \xr  man.  ( )f  the  3 j  deceased 
oarsmen,  only  2  ilieil  of  heart  disease,  1  of  consumption,  2  of 
Bright's  disease,  8  were  kilkil  in  the  Civil  War  and  by  accident, 
3  died  of  pneumonia,  2  of  ajjoiJexy,  i  of  dissipation,  i  of  imresis, 

1  of  cancer,  and  ic  of  unknown  cause*.  Tn  neither  of  the  2  cases 
of  heart  disease  was  rowing  given  as  the  cause.  The  after-health 
was  most  satisfactory  in  68,  gixxl  in  36,  and  (KX>r  in  1.    Only 

2  believed  that  rowing  had  injured  them,  one  claiming  to  have 
dysiwiisia,  and  the  Dther  an  enlargetl  heart,  which,  however,  had 
caused  him  no  inconvenience  since  he  left  colic;-'--  T'^cse  resi'Us 
would  seem  to  prove  conclusively  that  rowing  is  not  a  serious 
factor  in  the  production  of  early  death  from  arteriosclerosis  or 
other  circulatory  disorders;  but  it  must  be  remembered  that  these 
were  lives  doubly  selected— first,  for  constitutional  vigor,  and, 
secondly,  for  muscular  strength.  The  rfite  of  muscular  overwork 
in  the  proiluction  of  arteriosclerosis  must,  then,  be  looked  for 
rather  among  those  in  whom  it  is  carried  on  for  long  hours 
under  unsanitary  conditions,  like  the  miners  observe<l  by  Peacock, 
and  in  those  whose  advancing  age  and  hardening  tissues  do  not 
permit  of  the  rapid  recovery  from  overstretching  that  is  found  in 
the  normal  healthy  youth.  This  obscure  and  ill-understood 
disease  is  ascribed  to  habitual  overstrain  of  the  heart,  either  from 
the  excessive  use  of  alcohol,  overeating,  continued  mental  strain, 
or  from  prolonged  muscular  overwork.  If  was  first  described  by 
Peacock,  about  thirty-five  years  ago,  as  a  result  of  observations 
made  by  him  on  Cornwall  miners,  who  are  csijccially  subject  to 
continual  severe  muscular  strain.  His  obseriations  have  been 
confirmed  later  by  the  investigations  of  Myers,  Clifford-.Mbutt, 
DaCosta,  and  others. 


ATMltTICi  Al   rACTO.   IN   DUEAJI.  or   THK  CUC.IATION     jjj 

ArtcriosclerosH  i,  characterize!  by  hy|*rtro|.hV  ..f  the  heart 
high  tcn,.on  of  the  pulse,  rigidity  of  the  walls  of  the  hUKKl-v^sels' 
.ml  the  formation  of  calcareous  .le,)osit,  i„  the  artery  walls  The 
proce*,  seems  to  (««!„  by  a  breakinK-u,.  of  the  elastic  lilK.r,  of 
he  vensel-walls  and  the  formation  of  «:ar  tissue,  which  fmally 
become,  calcaneus.  I„  ,he  condition  of  atheroma  the  artery 
become,  hard  ami  fc^.j,  like  a  string  of  beads  under  the  finger 
The  cau«;  of  this  lowere.1  nutrition  in  the  vessel-walls  has  W-vn 
ascnljcl  by  Sir  Lauder  Brunton  to  the  .liminishe.1  pulsation  of 
the  vessel-wall,  caustKl  by  ,|,o  high  tension  and  the  loss  of  the 
norma  massage,  which  pro<luce<l  in  them  a  constant  interchange 
of  the  lymph  m  the  encircling  sheath.     Kach  time  that  the  artery 


is  dilated  by  the  blo«l  forced  into  it  by  the  heart-l«at  the  lymph  h 
<lr.ven  out  of  this  sheath,  while  with  the  following  contraction  of 
the  artery  more  fluid  again  flows  in  (Fig.  .86).     It  is  evident,  he 
says,  that  ,f  the  difference  between  the  size  of  the  artery  in  expan- 
sion and  contraction  is  great,  there  will  t«  a  corres,x,ndingly  free 
circulation  of  lymph  in  the  sheath  of  the  vessels,  but  if  the  difference 
IS  very  small,  the  movement  of  the  lymph  will  be  slow  an,l  imi^r- 
fect,  the  oscillation  of  the  vessel  being  .liminished;  and  it  is  a  fa^* 
that  continued  high  tension  within  the  arteries  leads  to  art.     , 
sclerosis,  to  degeneration  of  the  vessels,  fibrosis,  and  atheroma 
with  increased   liability  to  rupture,  causing  apoplexv.  or  to  car- 
diac hypertrophy  ami  subsecjuent  degeneration. 

Prolonged   muscular  overwork    may    act  as  a  cause  of  this 
condition  by  throwing  into  the  circulation  the  products  of  muscular 


'i-  i  I 


3»4 


EXERCISE    IN    EDUCATION    AND    MEDICINE 


waste,  particularly  hypoxanthin,  which  itself,  when  injected  into 
the  vessels  ex])erimentally,  will  i)roduce  abnormally  hi^h  tension 
and  atheroma,  but  the  continual  presence  of  a  systolic  pressure  of 
over  150  millimeters  of  mercury,  as  measured  on  the  Stanton  ma- 
chine described  in  Chapter  II.,  must  always  be  regarded  with  sus- 
jiicion.  When  the  diastolic  jjressurc  is  difikult  to  obtain,  by 
reason  of  the  smallness  of  the  oscillation,  the  suspicion  of  arterio- 
sclerosis will  be  strengthened,  and  if  the  radial  pulse  cannot  be 
entirely  obliterated  by  pressure  of  the  finger,  it  will  be  confirmed. 


iJHAPTER   XX 

THE  EXERCISE  TREATMENT  OF  DISEASES  OF  THE 
CKCULATION 

The  aim  of  exercise  is  to  reduce  a  high  pulse-rate  by  flushing 
the  peripheral  vessels;  to  ,»stpone  the  onset  of  breathlessness  by 
(leepenmg  the  respiration  and  improving  the  muscular  tone  of 
the  heart;  to  remove  the  incumbering  fat  which  muffles  its  move- 
ments; and  to  prevent  palj.itation  by  acting  both  directly  and 
mdirectly  on  the  cardiac  nerves. 

For  this  pur,K)se  exercises  of  effort  and  of  endurance  each  have 
had  their  advocates. 

Exercises  of  endurance,  like  walking  and  hill  climbing,  have 
had  their  chief  supjmrters  in  the  persons  of  Stokes,  of  Dublin  and 
Oertcl,  of  Munich. 

Exercises  of  effort  have  been  employed  from  the  time  of  Ling 
to  the  present,  with  such  advocates  as  Be.lv  Thome  (London) 
Heineman,  and  the  Schotts,  at  Bad  Xauheim.  Thev  have  always 
been  confined  to  single  efforts  of  the  most  simple  kind,  with  rests 
between  them,  accompanies!  by  massage  and  combined  with  regula- 
tion of  diet  and  the  administration  of  sim,,le  or  carbonated  brine 
baths. 

It  is  in  the  method  of  giving  and  the  dosage  of  exercise  that 
authorities  differ.  Wide  recommends  kneading,  rolling  an.l 
respiratory  movements.  He  uses  abdominal  massage,  which 
according  to  Levin's  researches,  can  reduce  an  overexcited  heart- 
rate,  while  Schott  and  others  claim  that  abdominal  massage  should 
be  prohibited  because  it  tends  to  inhibit  the  heart's  action  and  so 
prevent  aeration  of  the  blood. 

.All  movements  of  the  extremities,  esjiecially  the  legs,  draw 
the  blood  out  from  the  heart  and  abdomen  and  act  as  depletive 
influences.   The  back  trembling  given  by  Zander's  machine  fFig 


326 


EXERCISE   I.N    EDUCATION   AND   MEDICINE 


40)  has  a  powerful  infiuencc  in  reducing  a  rapitl  pulse,  as  have 
vibrations  given  along  the  back,  from  the  first  to  the  fourth  dorsal. 
These  procedures  have  the  added  acliantages  of  being  applicable 
to  a  patient  who  is  bed-ridden,  and  to  whom  movements  of  the 
arms  and  legs  must  be  given  with  the  greatest  caution.  In  slighter 
cases,  particularly  those  in  which  the  heart's  action  is  impeded  by 
deposits  of  fat,  the  endurance  required  for  Oertcl's  Terrain  Cure 
may  be  called  ujion.  Sir  William  Stokes,  as  early  as  1854,  wrote  of 
the  necessity  for  such  patients  to  "  pursue  a  system  of  graduated 
muscular  exercises"  for  the  symi)toms  of  breathlessness.  He 
states:  "This  treatment  1)/  muscular  exercise  is  obviously  more 
proper  in  younger  persons  than  in  those  advanced  in  life.  The 
symptoms  of  debility  of  the  heart  are  often  removable  by  a  regulated 
course  of  gymnastics  or  by  pedestrian  exercise,  even  in  mountainous 
countries,  such  as  Switzerland  or  the  Highlands  of  Scotland  or 
Ireland." 

While  the  Swedes  and  ihe  brothers  Schott  have  since  then 
emphasized  the  gymnastic  side  of  this  treatment,  the  "pedestrian 
exercise"  has  been  developed  l)y  Oertel  into  a  system  in  which 
he  combined  walking  and  hill-climbing  with  restriction  of  fluids. 
To  the  treatment  by  exercise  he  adds  the  drying  out  of  the  tissues. 
He  made  his  patients  walk  on  mountainous  roads  of  different 
steepness  for  a  period  strictly  regulated,  gradually  increasing  the 
time  and  steepness  of  the  road.  It  is  a  form  of  athletic  training 
beginning  very  cautiously,  and  based  on  the  principle  that  function 
makes  structure,  although  in  these  pathologic  conditions  it  must 
be  kept  strictly  within  the  limits  of  resistance  by  the  watchfulness 
of  a  physician.  His  system  was  founded  on  the  result  of  treatment 
in  his  own  case.  He  had  ky])hosis  from  a  fall  when  a  child,  rickets, 
and  a  hereditary  tendency  to  obesity  which  became  so  marked 
when  he  was  thirty  years  of  age  that  the  onset  of  dypsnea,  cyanosis, 
edema  of  the  legs,  and  a  diminution  of  the  urine  caused  him  to 
give  up  his  practice.  In  1875  he  left  for  a  mountainous  district, 
and  spent  there  the  month  of  .August,  where  he  first  experimented 
with  his  ideas,  against  the  advice  of  his  attendants,  for  at  that  time 
absolute  rest  was  enjoined  for  such  cases. 


EXERCISE    TKEATMENT    OF    DISEASES    Or    THE    CIRCLLATION      J27 

The  account  of  this  first  month  is  interesting.  The  first  and 
second  days  he  made  short  excursions  in  the  morning  and  afternoon 
on  level  ground,  and  climbed  a  hill  loo  meters  high.  Breathless- 
ness  and  palpitation  made  him  stop  after  taking  about  twenty 
steps  on  level  ground  and  after  ten  in  going  up  hill,  while  the  heat 
and  effort  made  him  perspire  profusely.  The  third  day  he  climljed 
a  hdl  157  meters  high.  When  sufTocatic,  seemed  inevitable  he 
rested  and  found  relief  in  taking  forced  breathing  while  resting 


Fig.  j87.-0>Tlcrs  pulse  tracing  before  beginning  trealment  (Lagrange). 


This  excursion  lasted  six  hours,  and  he  lost  much  weight  from 
perspiration,  but  that  night  he  had  neither  irregularity  nor  palpita- 
tion. 

In  the  second  week  he  could  climb  a  hilj  527  meters  high,  but 
It  took  him  four  hours-twice  the  time  for  an  ordinary  person 
He  had  to  stop  and  rest  150  times.  He  had  no  evil  effects  that 
night.  Owing  to  the  profuse  perspiration,  he  had  great  thirst 
which  he  relieved  by  gargling  cold  water,  but  he  did  not  drink  any 
more  than  usual. 


Fig.  i88.-Oerlels  pulse  tracing  after  six  weeks'  treatment  (Lagrange). 


After  four  weeks  he  began  to  take  longer  excursions,  and  found 
that  he  could  endure  them  with  comparative  ease,  aiiu,  although 
breathlessness  came  on  more  quickly  than  it  should,  the  normal 
action  of  the  heart  was  rapidly  reestablished  by  resting. 

In  six  weeks'  time  he  returned  to  Munich  and  again  took  up 
practice,  having  reduced  his  weight  eight  kilos.  His  pulse  remained 
normal  in  ordinary  walking  (Fig.  288),  and  he  could  go  up  two 


'1 


3»8 


EXERCISE   I.V   EDUCATION    AND   MEDICINE 


flights  of  stairs  without  breathlessness.  This  improvement  was 
Itept  up  by  periods  of  training  and  rest  for  eighteen  years,  when 
Lagrange  saw  him  and  reported  him  in  excellent  health. 

Shortly  after  his  return  to  Munich  he  began  to  establish  his 
cure.  The  one  at  Reichenhali  is  typical,  and  a  map  shows  the 
details  (Plate  i).  The  course  was  regulated  with  care  and 
minuteness.  The  paths  were  marked  with  stations,  benches 
were  placed  for  resting,  and  the  trees  beside  the  road  had  bands  or 
flags  of  red,  purple,  green,  or  yellow,  the  colors  representing  the 
degree  of  its  slant.  The  exercise  was  thus  prescribed  in  degrees 
of  increasing  distance  and  steepness. 

The  range  of  the  Oertel  cure  is  strictly  limited.  It  is,  first  of 
all,  a  preventive  measure,  and  can  be  employed  with  advantage 
to  improve  the  general  nutrition  and  to  prevent  fatty  infiltra- 
tion from  becom.ing  localized  in  the  heart.  Even  in  cases  where 
this  has  already  occurred  it  is  still  of  great  value,  as  it  also  is 
where  the  compensation  has  been  already  established  by  milder 
means. 

Where  compensation  is  broken  dov.-n,  and  where  the  patient 
is  compelIe<l  to  remain  in  bed,  massage  and  the  milder  trcatinent  by 
gymnastics,  which  are  under  more  accurate  control,  have  better 
results.  They  act  more  directly  upon  t'le  peripheral  circulation 
by  unloading  the  engorged  veins  without  unduly  overworking  the 
heart  itself,  and  such  a  course  iiiay  serve  as  a  good  preparation 
for  the  Oertel  treatment,  where  it  would  have  been  dangerous  to 
begin  with  it. 

The  application  of  massage  and  gymnastics  has  been  taught 
and  employed  since  the  time  of  Ling,  but  it  has  been  most  carefully 
studied  and  perfected  by  Auguste  and  Theodor  Schott  at  Bad  Nau- 
heim.  The  treatment  consists  of  regulated  movements  of  the 
iKxIy,  beginning  at  the  extremities  and  employing  the  large  muscle 
masses,  combined  with  massage  and  the  systematic  use  of  car- 
bonated brine  baths,'  such  as  are  found  at  the  Nauheim  springs. 
The  effect  of  the  baths  is  to  stimulate  and  flush  the  skin,  and  so 
reduce  the  frequency  of  the  pulse  and  increase  its  force.  They  can 
be  prepared  artificially. 


PLATE   I. 


EXERCISE    THEATUENT  OF   DISEASES   OF   THE   CIRCUtATION     339 

The  exercises  are  all  duplicate  movements,  and  each  one  must 
be  slowly  and  evenly  made,  with  a  definite,  firm  edort  on  the  i)art 
of  the  .,atient.  A  short  interval  should  be  left  between  them  to 
enjoin  slow  and  regular  breathing  and  to  prevent  the  possibility 
of  heart-strain.  The  patient  should  be  constantly  warned  of  the 
danger  of  holding  his  breath  during  the  effort,  for  by  this  act  an 
undue  and  unnecessary  strain  is  put  on  the  heart-walls  already 
impaired  by  disease.  The  exercises  should  stop  short  of  per- 
spiration and  palpitation,  and  the  0|K-rator  should  be  on  the  look- 
out for  dilatation  of  the  nostrils,  drawing  down  of  the  corners  of  the 
mouth,  duskiness  or  pallor  of  the  cheeks  and  lips,  yawning,  sweat- 
ing, or  paljiitation. 

The  pulse  should  be  frequently  examined  during  treatment, 
and  examination  before  and  after  treatment  should  show  a 
constant  reduction  in  the  dulness  over  Ixjth  the  heart  and  the 
liver,  accompanied  by  a  sense  of  general  relief  and  freedom  last- 
ing several  hours.  The  pulse  is  increased  in  volume  as  its  rate 
IS  reduced,  and  the  breathing  is  made  slower  and  deeper.  The 
color  of  the  lips  and  face  is  improved,  and  the  size  of  the  liver,  when 
congested,  is  notably  diminished.  Marked  diuresis  usually  follows 
after  a  few  days'  exercise. 

The  movements  cover  in  regular  order,  first,  the  muscles  of  the 
arms  and  forearms;  then  those  of  the  trunk,  thighs,  and  legs, 
exercising  mildly  every  important  group  in  the  bofly  by  single 
contractions. 

The  foUoA-ing  is  the  order  of  the  exercises  given  by  Bezly 
Thome,  in  his  book  on  the  "Schott  Methods  of  Treatment."  For 
further  instruction  in  the  position  of  the  operator's  hands  and  other 
particulars,  the  reader  is  referred  to  the  illustrations.  .\il  the 
movements  are  done  with  resistance  from  the  patient.  This 
resistance  must  be  made  very  mild  at  the  beginning  of  the  treat- 
ment, the  tendency  being  to  employ  too  much  force.  .■\s  the 
patient  shows  capacity  for  enduring  the  fatigue  the  amount 
of  resistance  may  be  gradually  increased,  but  treatment  should, 
if  anything,  err  on  the  side  of  safety,  especially  if  any  signs  of 
distress  are  noticed. 


Fig.  9QO. 


Figs.  289,  li}0.— Exercise  I.     Spread  Ihe  arms  (Fig.  289)  unlil  they  are  in  line  at 
tlie  level  of  the  shoulders.     Bring  them  together  (Fig.  290). 


Fig.  993. 

Figs.  291,  2t)3.~Exercise  II.     Flex  the  forearm  (Fig.  agi).     Kxtend  the  forearm 

(Fig.  39a). 

331 


m 


Fig.  3()4- 

T-igs.  2Q,^,  3Q4. — Exercise  III.     Raise  the  arm  sideways,  palma  upward  (Fig.  293)1 

until  the  thumbs  touch  above  the  head.     Sideways  lower  (Fig,  294). 

333 


Fig.  aqft. 

,K.  /„'*'■  'f'  '?"— f"'""  "■■     P""-'  "Vth"  'h-  knuckle,  „f  l«h  l,a„,U  wi.l, 
L<™er  .he  am,,  (f,,,.  .,„)  ,„  the  ,lartfng.,,„i„,,  i„  ,„,„,  of  ,),.  aM,„„en 


Fir.  ao8. 

Figs,  297,  298- — Exercise  W     Arms  forward  raise  (Fig.  297)  until  vertically  above 

the  Jita*i.     Furwafd  fuwcr  {.Fig.  iyJi). 

334 


f"i7     300. 

Figs.  JO,,  3oa-£»ro»  Vl.    Forward  flexion  of  the  trunk  (Fig.  359).     Exten- 

nion  (Fig.  300). 

335 


Fir.  30  a. 
Figs.  301,  302. — Exercise  VII.  Trunlt 
rotation.  The  operator  must  change  his 
position  from  Fig.  301  to  Fi^.  ^--a,  as  the 
patient  turns,  keeping  up  even  resistance 
throughout  the  entire  movement,  and  pass- 
ing partially  around  him. 


Fig.  303. — Exercise  VIII. 
Flex  the  trunk  to  the  right  and  to 
the  left  alternately.     Straighten. 


336 


EXERCISE   TREATMENT   OF   DISEASES   OF   THE   CMCULATION    337 


Exercise  7X.— This  move- 
ment is  identical  with  Exercise  II 
(Figs.  291,  292),  except  that  the 
fists  are  clenched. 


Exercise  X.— This  movement 
is  the  same  as  Exercise  IX,  ex- 
cept that  the  arm  is  at  the  side. 


Fig.  }Oi.—Extrdse  XI.  Rotate 
the  arm  forward,  upward,  back- 
ward, and  downward. 


Fig-   305— "EwTCTK   XII.      Push    both 
arm*  backward;  draw  them  forward. 


Figs.  306,  jaT.— Extra 


Fig.  30;. 
?  XIII.     Flex  the  ihigh,  with  knee  bent  (Fig.  306). 
ax.     Extend  the  thigh  (Fig.  307). 
338 


Fig.  309. 

Fig,.  ,c*,  }og.-J^ra^  X,V     E«e„d  the  leg  and  bring  the  straight  leg  f„,. 

ward  (Fig.  308).     Draw  the  leg  tackward  (Fig.  309). 


Fig-  3: 


Figs.  310,  },i.— Exercise  XV.     Flex  the  leg  ond  thigh  CFig.  310).     Ententi  the 
leg  (Fig.  311). 


1^ 


EXERCBE   TBEATMENT  OF   DISEASES  OF   THE  CIBCUIATION    341 


Fif^.  iiJ,— Exercise  XVI,     Alxluit  the  leg.     Adduit  the  !eg. 


Exercise  XVII. — Arms    extended    horizontally.     Rotate    for- 
ward and  backward  with  resistance. 


Fig-  3'3-— ^W'"  XVIII.     Extend  the  hand.     Flex  the  haml. 


34J 


EXEXCISE  IN   EDUCATION  AND  MEDICINE 


Fig.  314. — Exercise  XIX.     Flex  the  fotit.     Kxtend  the  ffiot. 


This  completes  the  full  set  of  exercises.  Many  patients  at 
first  are  unable  to  complete  the  entire  series.  The  resistance 
should  not  be  very  great  in  the  beginning,  and  should  be  increased 


Fig.  315. 


EXERCISE   TREATMENT   OF   DISEASES   OF   THE  CIRCULATION     343 

only  as  the  patient  shows  the  capacity  to  endure  it.  The  rate 
should  be  slow  and  uniform,  and  abundant  rest  given  between  each 
exercise  until  the  individual's  fx>wers  and  limitations  have  been 
gauged.     Most  of  them  may  be  done  in  bed  if  necessary. 

Some  form  of  artificial  respiration  has  been  used  by  others, 
and  may  be  profitably  added  to  any  treatment  of  these  conditions, 
either  in  the  forms  already  described  or  in  the  chest-raising  or 
shoulder-raising  (Fig.  315)  described  by  Satterthwaite,'  in  which 
the  patient  inhales  as  the  operator  lifts,  and  exhales  as  the  operator 
relaxes.  This  is  repeated  eight  to  sixteen  times,  with  one  or  two 
natural  respirations  between  each  movement.  Satterthwaite  has 
further  modified  the  technic  of  the  Schott  treatment  by  arranging 
the  exercises  in  series  of  progressing  diflSculty,  which  he  names 
schemes  I,  II,  and  III,  includiig  massage  of  the  thigh  and 
back. 

The  following  is  a  brief  outline  of  the  course  of  exercise  carried 
on  for  the  first  two  weeks: 


Scheme  N'c».  I 

r.  Chest  lifting,  lying  or  siuinx 2  minutes. 

Intermission i  minute. 

2.  Foot  and  leg  massage 2  minutes. 

Intermission i  minute. 

3.  Forearm  flexion  and  extension i       " 

Intermission i       " 

4.  Hand  and  forearm  massage 2  minutes. 

Intermission 1  minute. 

5.  Leg  and  thigh  flexion  and  extension 2  minutes. 

Intermission i  minute. 

6.  Arm  and  shoulder  massage 3  minutes. 

Intermission i  minute. 

7.  Thigh  flexion  and  extension 2  minutes. 

Intermission i  minute. 

8.  Chest  percussion a  minutes. 

Intermission i  minute. 

9.  Trunk  flexion  and  extension 2  minutes. 

Intermission i  minute. 

10.  Thigh  and  back,  massage 2  minutes. 

Total  length  of  seanre jg  minutes, 

*  "Intern.  Clinics,"  vol.  i.,  thirteenth  series. 


344 


EXEKCISE   IN   EDUCATION  AND   HEOICINE 


This  is  increased  in  severity  and  the  order  slightly  changed  in 
Scheme  No.  II,  which  is  carried  on  (or  the  third  and  fourth  weeks: 


[: 


SCHEMF.  No.   II 

t.  Chnt  lifting,  lyinK  or  sittinf; 3  minutes. 

Intermiiaion i  minutr. 

3.  Foot  and  leg  massage a  minutes. 

Intermission ...  i  minuie. 

3.  Forearm    N'xion  and  extension 3  minutes. 

Intermissum i  minute. 

4.  Hand  and  forearm  massage 3  minutes. 

Intermission r  minute. 

5.  Leg  abduction  and  adduction 3  minutes. 

Intermission i  minute. 

6.  Arm  and  shoulder  massage 1  minutes. 

Intermission i  minute. 

7.  Trunk  rotation , 3  minutes. 

Intermission i  minute. 

8.  Chest  percussion 3  minutes. 

Intermission i  minute. 

9.  Arm  separation 3  minutes. 

Intermission i  minute. 

10.  Thigh  and  back  massage 3  minutes. 

Total  duration  of  stance 33^mutesr 

Scheme  No.  Ill 

1.  Chcrr  lifting a  minutes. 

Intermission i  minute. 

a.  Foot  and  leg  massage 3  minutes. 

Intermission i  minute. 

3.  Quarter  ci.  iing  (forward  and  backward) 4  minutes. 

Intermission i  minute. 

4.  Hand  and  forearm  massage 2  minutes. 

Intermission t  minute. 

5.  Head  rotation  or  flexion 3  minutes. 

Intermission i  minute. 

6.  Arm  and  shoulder  massage a  minutes. 

Intermission i  minute, 

7.  Trunk  twisting 4  minutes. 

Intermission i  minute. 

8.  Chest  i)crcussion a  minutes. 

IntermisHon i  minute. 

9.  Trunk  flexion  (laterally) 4  minutes. 

Intermission. . . . .' i  minute. 

10,  Thigh  and  liack  massage 3  minutes. 

Total  duration  of  stance 37  minutesT 


«:XE«CISE    T«EATIIENT   OF    DISEASES   OF   IHE   CUCLLATION     345 

For  the  fifth  and  s.«th  weeks  a  further  change  in  the  series  U 
made,  and  some  new  e«rcises  are  introduced  that  might  not  be 
wel  borne  at  the  beginning  of  the  course,  particularly  ,,uarter 
circhng  and  head  rotation.  '    ' 

It  will  be  noticed  that  in  this  final  series  the  exercises  involve 
newer  and  larger  groups  of  muscles,  and  that  all  the  great  muscles 
o  the  body  have  been  exercise.!.  The  duration  of  the  stance  is 
also  onger,  and  more  force  should  te  applied.  The  movements 
should  be  very  slow,  and  the  intermission  should  be  carefully 
observe<l,  the  fault  of  the  o[«rator  being  usually  in  shortening  the 
mterm.ss,on,  mcreasing  the  amount,  and  using  undue  force  The 
pafent  should  also  be  urged  to  breathe  freely  and  naturally,  and 
the  operator  should  be  on  the  lookout  for  irregular  breathing, 
pallor,  blueness  of  the  lips  or  face,  or  any  sign  of  personal  discotn- 
fort  or  disturbance  on  the  part  of  the  patient.  Upon  the  appearance 
of  any  of  these  signs  exerr.-=e  must  be  suspended,  since  they  indicate 
hat  there  has  been  undue  resistance  or  that  the  movement  has  been 
loo  rapid  or  the  intervals  of  rest  curtailed.  Heineman,  of  Nauheim 
was  strongly  of  the  opinion  that  no  exercise  should  be  used  in  which 
the  hands  are  brought  above  the  level  of  the  shoulders,  on  account 

n   'uJT^"^-  '"'"'^  '">"'■'"*  "'  "•■^  ^^''  '■"  "•■''■"K  the  column 

of  blood    to  this  unaccustomed  height.     With  this  opinion   Sat- 

terthwaite  agrees.    Good  results  may  be  expected  from  exercise  in 

almost  all  disorders  of  the  circulatory  system  except  arteriosclerosis. 

.  he  exercise  treatment  is  unusually  successful  in  condition,  of 

heart  weakness  complicated  by  obesity,  where  improvement  should 

be  noted  from  the  first.    It  is  of  undoubted  value  in  most  valvular 

aisease,  with  signs  of  failing  compensation,  the  dilatation  of  the 

peripheral  vessels  resulting    from   the    exercises   being  followed 

by  an  improvement  in  the  strength  of  the  pulse  and  a  lowering  of 

the  rate,  an  improvement  that  may  be  maintained  for  years      In 

most  cases  the  patients  may  return  to  their  ordinarv  occupations 

and  duties,  and  if  signs  of  relapse  begin  to  appear, 'the  taking  of 

a  course  is  sufficient  to  reestablish  the  equilibrium  until  the  heart 

shares  in  the  inevitable  degeneration  of  advanced  old  age 


CHAPTER   XXI 
OBESITY  I    ITS  CAUSES  AND  TREATMENT 

The  excessive  accumulation  of  fat  must  lie  considered  as  a 
symptom  rather  than  as  a  disease.  It  is  due  to  ovemutrition,  to 
underoxidation,  or  to  a  combination  of  both  acting  together. 

When  the  allurements  of  the  table  are  too  great  for  the  body's 
needs,  the  surplus  is  stored  up  as  fat  in  the  tissues  least  disturtel 
by  muscular  action,  and  local  deposits  are  made  in  the  region  of 
the  abdomen  and  hijB  or  in  a  general  layer  throughout  the  sub- 
cutaneous tissue  of  the  entire  body. 

Heredity  has  a  marked  influence  in  this  fat-making  tendency, 
about  60  per  cent,  of  cases  reported  by  Anders  having  this  history, 
while  its  association  with  gout,  that  other  disorder  of  overfeeding 
and  underexercising,  was  found  in  43  per  cent,  of  his  cases.' 

The  normal  oxidation  of  the  ingested  food  may  be  hindered  by 
a  sedentary  life  involving  little  tissue  waste  from  muscular  exercise, 
or  by  the  mental  and  physical  torpor  and  habitual  inactivity  of 
the  too  ardc-nt  pupils  of  Silenus,  whose  fat  is  also  protected  from 
combustion  by  the  rapidly  oxidizing  alcohol,  which  retards  all 
tissue  waste,  and  so  favors  increase  in  bulk.  It  may  also  be 
hindered  by  lack  of  the  proper  functioning  of  the  thyroid  gland. 

Fat  is  a  cheaper  form  of  tissue  than  muscle,  requiring  as  it 
does  a  less  abundant  blood-supply,  and  its  presence  should  be 
considered  as  an  evidence  of  lowered  nutrition. 

As  the  amount  of  fat  increases  the  desire  for  exercise  diminishes, 
and  the  capa  v  for  activity  is  lessened,  because  of  the  speedy 
exhaustion  that  follows  any  unusual  muscular  work. 

Local  obesity  is  frequently  found  about  the  waist-line,  the 
deposits  occurring  in  the  abdominal  walls  and  in  the  mesentery 
and  omentum.    This,  when  excessive,  gives  rise  to  a  pronounced 
'  S«  "System  ot  Medicine,"  Osier  and  McCrae,  vol.  i,  846. 
346 


OBESITV:    ITS   CAUSES   AND   WEATIIENT  347 

deformity,  simulating  tumors,  pregnancy,  or  ilro|«y.  In  tlimt 
who  <lo  a  good  deal  of  walking  the  legs  may  remain  com,«ratively 
normal  m  size,  while  the  alxlomcn  is  |*nrlulous. 

DeiXMits  of  fat  ars  common  in  the  regions  of  the  neck,  giving 
rise  to  the  double  or  triple  chin,  and  in  women,  es|)ecia!ly,  it  tends 


F»  316.— General  deposit  of  fat  in  a 
young  man. 


Fig.  317, — Excessive  dei 
the  hips  only  (1 


Qsil  of  fat  about 
loore). 


to  accumulate  about  the  hips  and  buttocks,  the  Hottentot  Venus 
bemg  distmguished  by  the  size  of  her  buttocks,  due  to  the  exces- 
sive accumulation  of  fat  in  that  region. 

The  local  deposit  becomes  more  dangerous  when  it  is  in  the 
pericardium  and  about  the  heart-wall,  but  this  seldom  occurs 
unassociated  with  general  obesity. 


i 


348 


EXUCUE  IN  EDUCATION  AND  lUDICINE 


When  the  obesity  is  Keneral  in  its  distribution,  it  nuy  be  slight, 
moderate,  or  excessive.  The  degrees  have  been  admirably  char- 
acterized by  a  German  writer  as  the  enviable,  the  comical,  and  the 
pitiable  stages,  the  first  presenting  itself  as  a  pleasing  rotundity, 
the  second  as  a  jovial  "embonpoint"  of  the  FalstaCF  type,  and  the 
third  as  a  sad,  unwieldly,  and  disgusting  deformity. 

While  the  first  of  these  forms  recjuires  no  definite  treatment 
except  the  employment  of  every  effort  to  prevent  its  further  develop- 
ment, particularly  if  complications  are  present,  the  sccoml  or 
third  form  calls  urgently  for  reduction  by  diet  and  exercise. 

The  prognosis  in  any  particular  case  depends  on  the  reaction 
of  the  circulation  to  exercise.  If  the  onset  of  breathlessness, 
I>aIpitation,  irregularity,  and  thready  pulse  is  rapid  or  extreme, 
the  "outlook  is  gloomy"  (Anders).  If,  on  the  other  hand,  the 
perspiration  is  profuse,  the  general  condition  and  color  remain 
good,  and  the  pulse  strong  and  regular  after  exertion,  much  may 
be  expectetl  from  a  reduction  course. 

Most  of  the  causes  of  death  in  obese  cases  are  due  directly  or 
indirectly  to  affections  of  the  circulatory  system,  and  its  condition 
must  be  the  keynote  for  treatment,  as  was  recognized  by  Oertel 
in  his  "  terrain  cure, "  described  in  the  previous  chapter. 

The  fact  that  obesity  is  frequently  but  a  symptom  emphasizes 
the  necessity  for  a  prelimiiytry  examination  to  determine  the  pres- 
ence of  any  of  the  many  complications  that  are  \isually  associated 
with  it.  In  this  examination  habits  of  life,  particularly  with 
reference  to  diet  and  exercise,  should  be  note<l  fully  and  accurately; 
the  pulse  should  be  examined  carefully — lying  down,  standing; 
before  and  after  light  exercise,  like  forward  bending,  stationary 
running  or  hopping;  the  blood-pressure  should  be  estimated  and 
a  blood-count  made  to  determine  the  presence  of  anemia.  The 
lungs  should  also  be  examined  for  bronchitis,  and  a  series  of 
physical  measurements  taken,  including  the  weight  and  girths. 

In  all  diseases  that  imjx)sc  increased  work  on  the  heart,  like 
arteriosclerosis  or  emphysema,  there  is  hypertrophy,  with  danger 
of  dilatation  and  insufficiency,  especially  when  the  body  is  encum- 
bered by  excessive  fat.     The  reduction  of  this  fat  constitutes  one 


OBEUTV:  ITS  CAISM   AND  TREATIIINT  ^g 

of  the  mo.t  valuable  means  in  the  treatment  of  most  circulatory 
di«.«s,  unles..  they  are  «.  (ar  a.lvanc«l  as  to  ren.ler  ri-»l„ration 
of  the  heart  to  its  functional  activity  im,«ssible.  Case-,  in  which 
»liKht  .lisorrlen.  of  the  circulatory  ap,«ralus  are  presc.nt  Ki,e  the 
most  salisfactor)'  results,  while,  even  in  a.lvauce.1  cases,  improve- 
ment can  be  obtaini.1  by  Ix^inninK  Kra.lually  an.l  watching  the 
heart  condition  carefully.  When  complicatetl  by  -liseasi^  of  ,he 
kidneys,  hlic  atrophic  nephritis,  oU-sity  is  a  real  menace,  and  the 
reduction  is  not  contraindicaterl,  but  adviscfl  (\on  Noorden) 

(  hronic  bronchitis  is  a  fre.|uent  complication  of  oln-sity  and 
the  removal  of  su|H.-rtluous  fat  will  enable  the  |mtient  to  breathe 
more  .leej.ly,  encoura^inK  a  free  circulation  of  bloo.1  through  the 
lun^s,  so  that  such  cases  sometimes  heal  under  this  treatment 
alone. 

Chronic  articular  rheumatism  favors  ol«sity  bv  preventing  the 
patient  from  moving  freely,  |«rticularly  if  the  regions  of  the  leirs 
or  pelvis  are  affected,  .\„ders  found  it  in  35.5  |x.t  cent,  of  his 
cases  The  same  may  l«  said  of  gout,  the  reduction  treatment  of 
which,  through  diet  and  exercise,  is  of  the  first  im|K>rtance.  Most 
gouty  middle-aged  men  present  a  history  of  violent  in.lulgence 
m  physical  exercise  during  youth,  followe.1  bv  a  luxurious  and 
inactive  later  life,  with  overfeeding  ami  excessive  indulgence  in 
alcoholic  liquors. 

In  diabetes  a  reduction  cure  shouW  never  be  undertaken, 
especiaUy  if  the  obesity  be  only  slight  or  mo,lerate,  although  in 
cases  where  it  is  excessive,  accompanied  by  heart  symptoms,  the 
patient  should,  where  possible,  be  relieved  of  any  excessive  fat. 
Only  in  this  way  can  the  heart  l«;  protected  from  excessive  strain 
but  It  should  be  used  with  the  greatest  caution. 

In  selecting  cases  for  the  reduction  cure  three  considerations 
should  be  held  in  mind:  first,  the  amount  of  inconvenience  the 
obesity  causes;  second,  the  presence  and  extent  of  the  complica- 
tions referred  to  above;  and  third,  the  age  an.l  general  nutrition 
of  the  patient. 

When  obesity  is  moderate  or  extreme,  the  physician  may  be  con- 
sulted from  vanity,  which  may  thus  become  one  of  the  most  powerful 


350 


EXERCISE   IN   EDUCATION    AND   BfEDICINE 


levers  in  his  hands  to  insure  the  thorough  and  complete  carrying 
out  of  the  irksome  rules  that  the  patient  must  follow  if  the  desired 
result  is  to  be  obtained.  This  seemingly  trivial  consideration  is 
one  on  which  the  success  of  the  treatment  often  hinges  in  the 
ease-loving,  luxurious  class  from  which  so  many  of  these  patients 
come.  In  young  and  sound  adults  active  courses  of  five  weeks 
or  more  may  be  repeatctlly  undertaken  with  safety,  allowing 
intervals  during  which  the  loss  of  weight  is  merely  maintained. 
In  those  of  advancing  age,  where  the  obesity  is  extreme  and  the 
vital  energies  are  beginning  to  fail,  a  reduction  cure  would  only  ac- 
celerate decay  and  lead  to  rapid  loss  in  strength  and  functional 
I>ower,  with  the  continual  added  risk  of  heart  failure. 

Reduction  cures  may  be  divided  in^o  three  classes  or  degrees 
of  rapidity: 

1.  The  first  degree,  in  which  the  loss  is  very  slow,  the  patient 
losing  two  or  three  pounds  a  month.  It  applies  to  those  with  an 
enviable  amount  of  fat  which  shows  a  tendency  to  increase.  It 
does  not  require  great  sacrifice  from  the  patient,  who  must  alter 
her  diet  by  the  reduction  of  fat,  starchy,  and  sweet  foods,  restrict 
or  abandon  alcoholic  beverages,  take  only  foods  of  small  caloric 
value,  and  engage  in  regular  active  physical  exercise. 

2.  The  second  degree,  in  which  loss  should  be  from  five  to  ten 
pounds  a  month,  applies  to  strong,  plethoric  subjects,  who  can 
safely  indulge  in  active  exercise.  The  diet  is  more  strict,  and  the 
exercises  more  varied.  It  is  especially  valuable  for  individuals  in 
whom  complicating  disorders  of  the  heart,  arteries,  bronchi,  or 
digestive  apparatus  render  it  impossible  to  take  from  the  start  the 
more  rapid  or — 

3.  The  third  degree  of  the  reduction  cure,  which  should  be 
carefully  supervised  and  may  be  carried  out  at  an  institution  with 
a<lvantage.  As  much  as  thirty  pounds  a  month  can  be  lost  with 
safety,  but  five  or  six  weeks  is  the  longest  time  during  which  it 
should  be  put  in  force.  In  most  cases  it  will  be  necessary  to  carry 
it  on  for  four  to  six  weeks  and  then  have  a  month  or  two  of  less 
strenuous  exercise  and  regimen,  repeating  the  course  thus  inter- 
mittently until  the  desired  loss  of  flesh  has  been  attained. 


obesity;  its  causes  and  treatment  35 1 

The  reduction  treatment  falls  under  the  three  heads  of  ,liet 
exercise,  and  drug  therapy.  ' 

In  diet  the  caloric  requirements  are  reduced  to  four-lifths  of 
the  normal  in  the  first  course  described,  in  the  second  to  three-fifths 
and  m  the  third  to  two-fifths.     This  is  obtained  by  substitutinR 
for  more  nourishing  food  such  articles  as  bouillon,  coffee    or 
fruits,  which  have  small  caloric  value.     Lean  meats  should  be  given 
preference.     Cheese  often  ser;cs  a  useful  pur[»se,   particularly 
in  small  <|uantities,  as  it  is  very  filling.     Milk  is  a  useful  ad.lition 
to  the  bill  of  fare,  buttermilk  being  still  more  useful,     .\mong 
vegetables,  those  varieties  that  grow  under  ground,  as  well  as  those 
that  grow  in  a  jkxI,  should  be  restricted,  because  they  contain  a 
large  amount  of  carbohydrates.     .\11   the  other   vegetables   are 
CKeedi-gly  useful  articles  of  diet  if  they  possess  small  caloric  value 
m  proportion  to  their  bulk,  and  consequently  fill   the  stomach 
rapidly,  producing  ,,   sense  of  satiety.     They  also  act  favorably 
on  the  function  of  the  bowels.    Fruits  of  all  kinds,  with  the  excep- 
tion of  bananas,  sweet  grapes,  figs,  dates,  and  raisins,  are  permitte<l 
without  reserve,  as  they  have  a  low  coloric  value,  are  filling,  and 
act  well  upon  the  digestive  apparatus.     Bread  is  satisfying  to  the 
eye  without  possessing  great  caloric  value. 

The  intake  of  liquids  must  be  stricUy  limited.  The  weight 
of  an  obese  subject  is  rapidly  re<luced  by  restricting  the  liquids 
to  a  minimum.  This  loss  of  weight  is  particularly  apparent 
during  the  first  four  or  five  days  of  a  cure,  being  due  to  a  direct 
loss  of  water  from  the  tissues  by  the  air-passages,  skin,  and  kid- 
neys,  and  to  the  fact  that  one  is  inclined  to  eat  less  when  not 
drinking  freely.  It  also  causes  absorption  by  failing  to  restore  the 
amount  lost  by  perspiration.  This  rapid  initial  loss  is  of  great 
value  to  the  physician  in  giving  a  patient  confidence  in  the  method 
employed.  She  is  put  in  the  right  frame  of  mind  to  persevere  in 
carrying  out  the  distasteful  but  stringent  rules  that  must  be  en- 
forced. Occasionally  an  initial  rise  in  weight  is  noticed  during 
the  first  few  days  on  account  of  the  increased  metabolism  and 
improved  nutrition  following  unaccustomed  exercise. 

Boxers  and  jockeys  who  have  to  reduce  their  weight  rapidly 


35» 


EXERCISE   IN   EDUCATION   AND   MEDICINE 


to  a  set  figure,  much  below  their  normal,  accomplish  it  by  profuse 
sweating  and  abstaining  from  liquids.  When  excessive,  this  is 
most  exhausting  to  the  system,  and  in  making  matches  or  contests, 
it  is  frequently  stipulated  that  the  man  be  weighed  six  or  eight 
hours  before  a  fight,  so  that  this  abnormal  loss  of  weight  may  be 
regained  in  part  and  the  strength  restored  by  eating,  and  drinking 
copiously  of  fluids  before  the  beginning  of  ihe  contest.  From 
five  to  ten  pounds  may  thus  be  gained  in  a  few  hours.  Losses  of 
weight  up  to  fourteen  pounds  in  an  hour  and  a  half  have  been 
reported  during  foot-ball  games  in  men  at  the  beginning  of  training 
by  A.  A.  Stagg,  of  Chicago  University,  and  James  Naismith, 
of  the  University  of  Kansas,  entirely  and  rapidly  regained  after 
eating  and  drinking. 

The  patient's  general  mode  of  life  must  be  regulated,  always  a 
difficult  feat  to  accomplish.  Habits  of  ease  and  indolence  should 
be  replaced  by  greater  general  activity,  and  interest  in  outdoor 
games,  like  golf  and  walking  excursions,  should  be  created  to 
impel  her  to  take  a  large  amount  of  general  exercise. 

The  influence  of  massage  is  very  problematic,  according  to 
Von  Noorden's  experiment,  referred  to  in  Chapter  III.,  and  it  is 
to  the  more  active  forms  of  exercise  we  must  go  for  the  best 
results. 

When  the  accumulation  of  fat  is  unevenly  distributed,  a  daily 
prescription  of  ten  exercises  should  be  given,  to  include  the  entire 
muscular  system,  but  with  emphasis  on  the  regions  where  the 
deposit  is  thickest,  for  fat  tends  to  accumulate  in  the  subcutaneous 
tissue  covering  the  groups  that  are  dormant,  like  the  abdominals 
or  muscles  of  the  neck.  Such  exercises  have  been  shown  in 
Figs.  34,  91,  161,  169,  170,  327,  328,  and  329. 

'  When  the  omentum,  mesentery,  and  ab<lominal  walls  are 
excessively  overburdened,  the  exercises  shown  in  Figs.  91.  327, 
328.  and  329  are  of  special  value.  To  these  may  be  added  the 
three  following,  and  selection  made  from  them  all  to  suit  the 
special  case; 

Exercise  I. — Patient  lying  supine,  arms  above  the  head,  grasp- 
ing a  supiKjrt.    Raise   both  feet  twelve  inches  without  bending 


obesity:  its  causes  and  treatment  353 

the  knees.  Alternately  raise  and  lower  the  feet  (Fig.  318)  ten 
times  without  touching  the  table.  The  extent  of  the  raising  and 
lowering  should  not  be  more  than  twelve  inches. 


Fin-  3'S- 


This  brings  the  abdominal  muscles  into  action,  and  should  be 
repeated  with  rests  up  to  thirty  times. 

Exercise  //.—Patient  lying  supine,  hands  on  the  hips.  Raise 
the  head  and  shoulders  until  the  feet  can  be  seen.  Twist  to  the 
right,  to  the  left,  and  slowly  return  to  the  starting  position  (Fig. 
326).  This  may  be  used  as  an  introductorj'  exercise  to  the  next, 
in  which  the  same  muscles  are  employed  with  greater  vigor. 


•  Exercise  ///.—Patient  lying  supine  with  the  feet  Hxed  and 
hands  clasped  behind  the  head.  Raise  the  body  to  the  upright 
position,  and  slowly  lower  to  the  starting-point  (Fig.  319).    ThU 

'3 


354 


EXERCISE  IN   EDUCATION   AND  MEDICINE 


may  be  accentuated  by  having  the  trunk  overextended,  as  in  Fig. 
330,  which  is  a  form  of  the  same  exercise  which  can  be  rendered 
more  difficult  by  having  the  arms  behind  the  head  as  shown  in 
the  position  of  Fig.  319. 

.\  prescription  should  begin  with  the  lightest  exercise,  and  the 
dosage  should  be  increased  rapidly  in  length  and  severity  according 
to  the  muscular  strength  and  the  condition  of  the  pulse. 

After  each  of  the  first  two  or  three  treatments  massage  is  of 
distinct  value  in  relieving  the  muscular  soreness,  but  it  seems  to 
have  no  direct  effect  in  reducing  the  weight. 


Fig.  390. 

Accompanying  this  gymnastic  treatment,  regulated  walking, 
at  first  on  level  ground,  and  then  up  an  increasingly  steep  incline, 
is  of  the  utmost  value,  beginning  with  a  climb  sufficient  to  produce 
moderate  breathlessness,  and  increasing  the  length  and  steepness 
as  the  patient's  ability  improves.  This  is  the  Oertel  "terrain 
cure, "  as  described  fully  in  the  previous  chapter. 

The  elimination  of  fluids  may  be  increased  by  the  use  of  such 
aperient  waters  as  those  of  Kissingen  or  Vichy,  which  are  used  on 
alternate  days,  one  glass  every  morning  before  breakfast  or  at 
night. 

The  principal  medicinal  agent  employed  in  reduction  cures  is 
extract  of  thyroid  gland,  given  in  doses  up  to  five  grains  three 
times  a  day,  and  stopped  prompdy  if  any  sign  of  heart  distress  or 
weakness  appears. 


obesity:  its  causes  and  tkeatment  355 

A  daily  treatment,  such  as  outlined  al»ve,  accompanied  by 
P">per  regulation  of  the  diet,  should  steadily  and  consistendy 

In  one  of  my  patients,  a  young  lady  aged  twenty,  it  was  reduced 

mol     TT    7;°"  •"""'^  '"  '''  P"™''"  '■"  '^  I-o"  of  fo^ 
months,  which  mcluded  several  weeks  lost  by  inter;up,ions.     By 

a  very  much  modified  home  prescription  this  improvement  wal 

mamtamed  at  the  last  examination,  taken  six  months  afteTar.! 

George  Cheyne,  bom  m  Scotland  in  i6;..     By  the  time  he  was 
thirty  his  excesses  in  eating  and  drinking  had  brought  his  weight 

In^  ^hot  breathed,  lethargic,  and  listless.    He  dieted  on  milk 

one-.hird  (.50  pounds).     He  recovered  his  strength,  and  lived  to 
the  age  of  seventy-two,  writing  an  essay  on  health  and  long  life 

fro™  ^""1"  '"'"'"'™  """'  '^'  ''""'  *'^°"'''  ^  ^""'""y  ^^amined 
or  edema  of  the  extremities  are  found.  Sometimes,  when  loss  of 
weight  IS  rapid  and  obtained  by  means  of  drugs  and  diet  alone 
without  care  to  improve  the  muscle  tone  and  so  to  support  the 
viscera,  certain  complications  arise  (constipation,  hernia,  and 
gastroptosis),  particularly  in  middle-aged  and  flabby  women  Dis- 
placement of  the  kidneys  and  uterus  may  also  be  traced  to  the 
rapKl  absorption  of  the  surrounding  fat,  and  symptoms  caused  by 

Zt  T^"".  '"!r  "'''''  '^"  ^''""''  ">  ^'  '"°'-  troublesome 
than  the  obesity  itself. 


CHAPTER   XXII 
OTHER  DISORDERS  OF  NUTRITION 

GOOT,   DIABETES,   RHEUHATISSI.   GASTRITIS,   CONSTIPATION, 
AND  HERNIA 


The  rflle  of  exercise  in  the  prevention  and  treatment  of  gout 
occupies  an  important  place  in  every  discussion  of  this  disease. 

Like  obesity,  with  which  it  is  so  often  associated,  gout  is  usually 
a  disease  of  ovemutrition  and  underelimination,  and  the  indica- 
tions would  be  to  decrease  the  intake  and  increase  the  excretion 
of  waste  by  all  the  avenues. 

The  rules  for  diet  are  still  the  subject  of  dispute,  but  all  writers 
agree  that  exercise  is  of  great  value  in  reducing  the  weight  of  the 
gouty  patient  when  obese,  and  of  increasing  the  activity  of  the 
skin  and  lungs. 

The  nature  and  dosage  of  the  exercise  must  be  regulated 
according  to  the  condition  of  the  patient. 

In  young  and  vigorous  subjects,  almost  any  of  the  active 
athletic  sports  appropriate  to  their  age  may  be  engaged  in  (These 
are  enumerated  in  the  Table  of  Sports,  in  Chapter  VIII.) 

The  great  majority  of  patients  will  require  exercises  of  endur- 
ance, like  walking,  which  should  be  regulated  in  distance  and 
speed.  Golf  has  a  peculiar  value,  from  the  fascination  it  possesses 
for  individuals  of  all  ages,  a  point  not  to  be  lost  sight  of  in  the 
management  of  self-indulgent  cases.  Horseback-riding  has  the 
added  advantage  of  vigorous  massage,  especially  if  the  horse  be 
trotted,  and  if  the  ravenous  appetite  resulting  from  the  open-air 
exercise  be  kept  within  the  limits  of  discretion. 

For  those  who  are  unable  to  take  more  active  exercise  a  course 
of   gynmastics,    including   duplicate   passive   manipulation   and 

3S« 


OTHEK   DISORDERS   OF   NUTRinON 


357 


It  must  not  be  forgotten  that  a  debauch  of  exercise  in  a  vaktu- 
dinanan  may  precipitate  an  acute  attack  by  throwing  into  the 
crculauon  suddenly  the  fatigue  products  and  causing  an  acute 
po,sonmg,  so  that  great  care  should  be  observed  to  begin  gradually 
and  mcrease  the  amount  as  the  system  accommodates  itself  to  the 
necessity  for  more  active  excretion. 

an/?'°^ !!"  '"^"''  '■''°'''  '"  *'"■'''  ''"""y  l™*'^'"'  fl<«k  acquire 
and  retam  their  reputation  because  of  the  healthy  and  mod.-rate 
regimen,  purgative  waters,  and  regular  habits  that  are  required  of 
patients  taking  the  cure. 

DIABETES 

In  the  hygienic  treatment  of  diabetes  exercise  has  an  important 
place,  since  muscular  action  favors  the  combustion  of  sugar,  from 
whatever  source  it  may  be  derived,  and  among  diabetics  the 
^"H^       ^on«ipation  favors  the  onset  of  coma 

When  present,  constipation  should  be  corrected  by  local  and 
general  massage  daily,  and  by  the  simpler  forms  of  free  or  dupli^te 
movements.  "upuuiie 

four!LtTJ'"'''';'.,°'  ^°""'  '""^  «™"^'  ""^'^  ""fading  in 
fourteen  diabetics  daily,  a  twenty-minute  treatment  being  gfven 

a  m«ed  diet.    There  was  a  constant  diminution  in  urine,  decrease 

Wh     Z"^'"  '"'  "^^  ""«"''  ""'1  "^'"™  °'  perspiration. 

When  the  patient  ,s  sufficiently  strong,  he  should  be  made  to 
live  as  much  as  possible  out-of-doors  in  a  dry,  warm  climate  and 
a  dai^y  .ask  should  be  set  for  him.  The  exercise  shouldt  genUe 
in  character  and   carried   out  systematically.      Gardening  and 

itn^'n'^M  r  ''""'■''  ^''°"'"  "^  '"^  f"™^  -'«'«d.  but  the 
patient  should  be  warned  to  stop  within  the  limits  of  fatigue 

toriuni^T  """.^  ""'"^  °"  '"  ""'  ^''  '"'™'»K*  '"  a  »na. 
nlT'  !,  "^  '  conveniences  for  bathing  and  massage  are 
found,  and  where  the  habits  of  life  can  be  regulated  with  Lter 
hope  of  success. 


358 


EXERCISE  IN   EDUCATION  AND   MEDICINE 


■HEUMATISM 

The  manifestations  of  rheumatism,  whether  they  appear  in  the 
muscles  or  in  the  joints,  may  often  be  treated  by  vibration  and 
massage,  with  very  considerable  success. 

In  muscular  rheumatism  the  stemomastoid,  the  erector  spins 
muscles,  and  the  lumbar  fascia  are  favorite  sites  for  the  attack. 
There  is  probably  a  coagulation  of  the  semifluid  muscular  sub- 
stance, with  adhesions  and  retention  of  waste-products,  of  which 
uric  acid  is  the  worst,  causing  pressure  upon  and  irritation  of  the 
nerve-filaments,  and  spasm  of  the  muscles. 

The  pain  of  this  condition  is  exceedingly  acute,  and  requires 
rest  and  counterirritation. 

Vibration  may  be  applied  to  inhibit  the  pain,  by  using  the  ball 
attachment,  a  medium  stroke,  and  deep  pressure  several  times  a 
day  over  the  spinal  centers  governing  these  parts,  and  the  soft 
brush  and  rapid  stroke  over  the  affected  parts  themselves  several 
times  a  da  If  the  pain  Is  acute.  Massage  is  also  useful,  after  the 
acuteness  has  abated,  in  soothing  the  irritation  by  gentle  stroking 
and  friction,  increasing  in  force  with  the  improved  toleration  of 
the  subject.  The  evils  resulting  from  forced  Inaction  In  patients 
who  are  suffering  from  muscular  rheumatism,  either  In  the  lumbar 
region  or  elsewhere,  is  counterbalanced  better  by  gem-ral  massage 
than  In  any  other  way.  The  movements  used  vary  from  gentle 
stroking  to  deep  kneading  of  the  muscle  masses,  with  manipulation 
to  extend  the  stiffened  joints  gradually,  but  without  causing  severe 
persistent  pain. 

Arthritis  deformans  Is  an  incurable  disease,  but  the  inevitable 
progress  of  deformity  can  be  held  back  and  great  comfort  can  be 
given  to  the  patient  by  vibration,  massage,  and  manipulation. 

Ankylosis  t-My  be  prevented  by  checking  the  formation  of 
adhesions,  and  the  stretching  and  breaking  down  of  those  already 
formed,  while  atrophy  of  the  muscles,  always  a  pronounced 
symptom,  may  be  delayed. 

Douglas  Graham  reports  most  encouraging  results  in  a  number 
of  cases  treated  by  himself,  five  out  of  six  showing  marked  improve- 
ment.    His  mode  of  procedure  was  deep  manipulation  without 


OTHEK   DISORDERS   OF   NUTRITION  359 

friction,  passive  motion  as  far  as  the  pain  would  allow,  and  some- 
times fartiier,  and  resistive  movements  as  soon  as  tliey  could  be 
done.  He  disregards  pain  if  it  rapidly  disappears  after  the  treat- 
ment; if  it  persists,  treatment  must  be  suspended. 

He  recommends  kneading,  with  one  hand,  to  break  up  indura- 
tions or  disperse  effusions,  while  the  other  pushes  along  the  circu- 
lation in  the  veins  and  lymphatics  alxjve  the  joint. 

Massage  would  not  be  used,  of  course,  when  the  disease  is  very 
active.' 

Graham  quotes  the  case  of  .Wmiral  Henry,  who  was  a  sufferer 
from  this  affliction  for  twenty-eight  years.  In  1810,  at  the  age  of 
seventy-nine,  he  was  quite  crippled,  but  by  means  of  various 
mstruments,  made  of  bone,  polished  smooth,  and  hammers  covered 
with  cork,  he  persevered  in  the  use  of  deep  friction  and  percussion 
night  and  morning  for  three  years.  .At  the  end  of  this  time,  it  is 
said,  he  had  completely  succeeded  in  removing  the  sweUings  and 
restoring  the  use  of  his  limbs.  At  the  age  of  ninety-one  he  wrote 
to  a  friend:  "I  never  was  better,  and  at  present  am  likely  to 
contmue  so.  I  step  up  and  down  stairs  with  an  ease  that  surprises 
myself.  My  digestion  is  exceUent,  and  every  food  agrees  with 
me.  1  can  walk  three  miles  without  stopping."  Unfortunately, 
such  a  case  is  so  exceptional  as  to  have  been  passed  down  as  <me 
of  the  modem  miracles. 


OASTWns 

Among  the  most  amenable  of  the  disturbances  of  nutrition  to 
treatment  by  exercise  are  constipation  and  certain  cases  of  chronic 
gastritis  and  diarrhea.  Much  attention  has  already  been  called  to 
the  inevitable  disturbances  of  the  digestive  organs  found  in  those 
leading  a  sedentary  life,  especially  if  they  are  gormandizers.  But 
there  is  a  class  of  cases  in  which  the  gastric  disturbances  are  due 
to  nervous  causes  much  more  than  to  indiscretion  at  the  table. 
In  advising  massage  or  active  movements  for  cases  of  chronic 
gastritis,  great  care  should  be  taken,  as  in  diabetes,  to  stop  the 
exercise  before  reaching  the  poim  of  exhaustion,  and  mild  exercises 

*  Gmham,  "Masiiige,"  410. 


"•       : 


3*0 


EXEBCI8E  IN  EDl'CAnON  AND  MEDICINE 


of  endurance,  like  walking,  In  addition  to  massage  of  the  alxlominal 
walls,  should  be  the  forms  recommendeil. 

In  nervous  dyspepsia,  which  is  so  frequently  a  symptom  of 
neurasthenia  or  hysteria,  the  rest  cure  of  Weir  Mitchell,  with 
careful  regulation  of  the  diet,  massage,  and  light  resistive  exercises, 
leading  on  to  more  active  movement:),  should  be  given.  In  all. 
such  cases  of  gastritis  massage  should  be  given  about  two  hours 
after  a  meal,  and  should  include  pressure  and  kneading  of  the 
hyixxhondriuc  and  epigastric  regions,  from  left  to  right  and 
downward. 

These  movements  give  immediate  relief  in  some  cases.  They 
force  the  stomach-contents  into  the  duodenum,  stimulate  the  action 
of  the  liver,  and  alternately  compress  and  relax  the  gall-bladder. 
They  should  be  followed  by  kneading  along  the  course  of  the  colon, 
and  vibratory  massage  over  the  spine,  from  the  fourth  to  the  tenth 
dorsal,  whenever  tender  points  can  be  made  out.  The  relief  from 
the  feeling  of  oppression  and  the  more  distressing  ner\'Ous  symptoms 
so  frequently  present  in  these  conditions  is  often  rapid  and  com- 
plete. 

CONSTIPATION 

Constipation  may  be  due  to  constitutional  peculiarities,  to 
sedentary  habits,  to  certain  diseases,  such  as  anemia  or  neuras- 
thenia, chronic  affections  of  the  liver  and  stomach,  or  the  abuse  of 
purgatives.  A  general  atony  of  the  intestines  accompanies  weak- 
ness of  the  abdominal  muscles  in  obesity  and  debility,  and  lassitude, 
headache,  and  mental  depression  are  the  most  frequent  symptoms 
which  attend  it;  but  persistent  constipation  may  exist  for  weeks 
without  other  symptoms.  Individuals  differ  greatly  in  this  respect. 
A  careful  inquiry  into  the  probable  causes  should  be  made  in  all 
cases  of  constipation.  Some  change  in  diet  or  occupation  may  be 
responsible,  as  is  so  frequently  found  among  college  students  after 
leaving  home.  About  12  per  cent,  of  college  students  complain 
of  constipation  in  their  preliminary  physical  examination,  and 
most  satisfactory  results  have  been  obtained  by  having  them 
follow  a  list  of  five  simple  exercises  for  the  abdominal  muscles, 
which  are  repeated  daily  twenty  times  each. 


OTHU   DISOIOERS  OF  Nl'T«ITION 


36" 


When  the  causes  arc  complicated  and  the  condition  i«r»istent 
all  the  resources  of  exercise  should  be  brought  to  bear  on  the  case, 
as  well  as  the  ri,'ulation  of  the  diet  and  the  drinking  freely  of 
mineral  waters  or  other  light  laxatives. 

The  application  should  be  in  the  form  of  massage,  vibration, 
duplicate  and  actiw  movements,  and  the  cultivation  of  regular 
and  systematic  habits.  The  massage  shouUl  be  very  dee[i  and 
slow,  following  the  course  of  the  colon,  beginning  in  the  right  iliac 
region,  passin^i  upward  to  the  ribs,  across  the  alxlomen,  just  al>ove 
the  unbilicus,  and  <lown  the  left  side,,  terminating  in  deep,  s|„w, 
circular  movements  in  the  left  iliac  region,  over  the  sigmoid  flexure 
and  the  rectum  (Fig.  321).     These  kneading  movements  should 


Hating  prcMure  maiMge  (0«ntl. 


be  done  very  slowly,  with  firm,  deep,  and  insistent  pressure,  ih. 
knees  of  the  patient  being  drawn  up  and  the  aMomianI  walls  re- 
laxed. 

This  part  of  the  treatment  should  last  at  least  ten  minutes  daily 

A  cannon-baU  covered  with  chamois  leather  has  been  used  for 

the  same  purjwse,  and  most  sanatoriums  have  the  Zander  machine 

on  which  the  patient  lies  face  downward,  the  aMomen  resting  on 


36» 


IXEKCUE  IN  KOUCATION  AND  MtUICINE 


a  looM  leather  (iiaphraKKi.  Iwneath  which  a  ball,  set  in  motion 
by  a  motor,  follows  the  course  of  the  colon,  giving  continuous 
upward  pressure.  These  movements  arc  not  so  effective,  however, 
as  the  traine<l  human  hand.  The  administration  of  vibrations  alonf; 
both  sides  of  the  spine,  from  the  first  to  the  fourth  lumlwr,  will 
alone  give  immoliate  relief  in  some  cases.  Mas.sage  alone  is 
scarcely  ever  sufficient  in  the  treatment  of  cnnsti|>ation,  accord- 
ing to  Bolin,  ami  certain  active  movements  are  necessary  to 
supplement  the  more  |»issivc  forms. 

Among  the  exercises  that  have  proved  of  value  may  Iw  cited 
the  turning  of  the  nautical  wheel  (Fig.  34)  and  the  trunk  rota- 
tion described  in  Exercises  I  and  II  for  abdominal  weakness 
(Figs.  326,  327,  338). 

Two  exercises  may  be  described  that  act  directly  by  pressure 
on  the  abdominal  contents: 

Exercise  I. — Patient  lying  supine  on  a  couch,  arms  at  the 
sides.  Raise  the  right  leg  with  knee  bent.  Clasp  the  hands  over 
it  and  press  it  in  against  the  abdominal  wall.  Repeat  with  the 
left  (Plate  II,  Fig.  i).    Repeat  twenty  times. 

Exercise  //.—Patient  sitting  astride  a  plinth,  arms  behind  the 
back.  Trunk  circumduction  bending  well  forward  to  the  right, 
then  forward  and  to  the  left  (Plate TI,  Fig.  a).  Repeat  twenty  times. 

Circumduction  of  the  pelvis  is  given  most  effectively  by  Zander's 
"camel,"  the  patient  sitting  on  an  eccentrically  moving  saddle, 
or  on  the  "  horse, "  which  is  a  substitute  in  movement  fop  the  trot, 
and  riding  on  horseback  itself  is  to  be  strongly  recommended 
when  available. 

The  effects  of  treatment  should  be  noticed  from  the  first,  and 
relief  is  usually  immediate  and  made  permanent  by  continuing 
the  improved  physical  habits. 


Weakness  of  the  abdominal  muscles  and  fascia  is  responsible 
not  only  for  many  of  the  more  chronic  affections  of  the  gastro- 
intestinal tract,  due  to  insufficient  support  or  to  lack  of  the  normal 
massage,  which  the  diaphragm  and  the  abdominal  walls  should 


PI  AfK   II 


OIHEK  DISORDERS  OF  NUTRITION 


363 


give  to  them,  as  already  described,  but  the  relaxation  of  the 
openings  through  which  the  blood-vessels  and  other  structures 
pass  out  of  the  cavity,  leads  to  actual  hernia  of  the  viscera. 

When  hernia  takes  place  at  the  umbilicus,  there  is  a  stretching 
of  ihe  fibrous  tissue  alone.  When  it  takes  place  at  the  femoral 
ring.  It  IS  merely  a  dilatation  of  the  innermost  compartment  of 
the  femoral  sheath.  Inguinal  hernia,  which  is  very  much  the  most 
common  form,  is,  however,  in  part  due  to  a  stretching  and  spreading 
apart  of  muscle  and  tendon,  and  exercise  may  be  of  marked  as- 
sistance  in  strengthening  and  closing  the  internal  and  external 


t-ower  part  of  internal 
oblique   thrown  for- 


Fascia  tranaversalis 

Spermatic  cord 

Poupart's  ligament 


Fig.  3jg.   -Deep  layer,  showing  internal  ring  and  transversalis  muscle.    The  dotted  line 
shows  the  attachment  of  internal  oblique. 

abdominal  rings,  and  ;«  helping  to  guard  against  its  advent  or 
prevent  its  return. 

A  careful  diagnosis  is  essential  to  exclude  femoral  hernia,  and 
certain  cases  in  which  the  bowel  does  not  enter  the  internal  ring, 
but  breaks  through  the  conjoined  tendon  directly  beneath  the 
external  ring. 

The  internal  abdominal  ring  is  found  just  beneath  the  cres- 
centic  arch  of  the  inferior  border  of  the  transversalis  muscle. 
It  is  at  this  point  that  the  vas  deferens  in  the  male  and  the  round 
ligament  in  the  female  enters  the  abdominal  wall.  The  trans- 
versalis Ukes  its  origin  from  the  outer  third  of  Poupart's  ligament. 
The  internal  oblique  has  its  origin  from  the  outer  half,  :»  that  its 
lower  fibers  cover  the  internal  abdominal  ring  as  by  a  lid,  and  the 


364 


EXERCISE  IN   EDUCATION  AND  MEDICINE 


development  of  this  muscle  has  a  distinct  influence  on  the  ring's 
integrity-  The  external  abdominal  ring  is  a  slit  between  the 
tendinous  pillars  of  the  external  oblique,  and  every  contraction  of 


Fasda  transvenalis 

Spermatic  cord 

Poupart's  ligament 


Fig.  323. — Attachment  of  internal  oblique,  showing  the  covering  of  the  cord. 

this  muscle  pulls  these  pillars  together,  closing  it.  This  action 
of  the  muscle  serves  as  an  automatic  protector  of  the  opening 
during  active  exercise. 


Poupart's  ligament 
Gimbemat's  liga- 
ment 


Intercolumnar  fibers 


External  abdominal 

ring 
Outer  or  lower  pillar 

of  external  aboomi- 

nal  ring 
Fascia  tnangularis 


Fig.  324. — Superficial  layer  and  external  abdominal  ring. 

The  inguinal  canal,  which  is  normally  collapsed,  is  bounded, 
then,  superficially  from  without  inward,  first,  by  the  external 
and  internal  oblique;  second,  by  the  external  oblique  alone. 
Hernia  may  enter  the  canal  at  the  internal  ring,  or  break  in  through 


OTBER  DISOKDEKS  OF   NUTRITION 


365 


the  fascia  that  guards  its  center  or  inner  end,  tearing  ahead  of  it 
or  pushing  aside  the  weakened  conjoined  tendon  of  the  trans- 
vcrsalis  and  internal  oblique;  Ijut  in  all  cases  it  makes  its  exit  by 
spreading  apart  the  columns  of  the  external  abdominal  ring. 

In  threatened  or  actual  inguinal  hernia  much  can  be 
done  by  strengthening  the  external  and  internal  oblique  and  the 
transversalis  muscles  by  active  movements.  The  most  suitable 
cases  for  this  treatment  are  in  children  and  adolescents,  where  the 
condition  is  not  congenital  and  where  natural  growth  assists  in  the 
process  of  repair,  although  good  results  have  been  obtained  up  to 
fifty  years  of  age,  either  where  hernia  is  actually  present  or  where  . 
there  seem  to  be  the  premonitory  symptoms.  One  is  frequently 
consulted  for  a  dull,  aching  pain  either  in  one  or  t)oth  inguinal 
regions,  particularly  after  some  unusual  muscular  strain  or  fatigue, 
by  patients  who,  on  examination,  show  unusually  dilated  external 


I^'B-  325— Seaver's  fiat  truss  iMWi, 

rings.  There  is  tenderness  and  a  distinct  impulse  on  coughing, 
but  no  actual  hernia.  Others,  again,  in  whom  hernia  is  present 
complain  of  no  inconvenience  from  it. 

One  man  played  foot-ball  for  years  with  an  enormous  scrotal 
hernia,  which  he  did  not  even  support.  He  then  went  to  Cuba, 
did  a  great  deal  of  horseback-riding  and  other  violent  exercise, 
during  which  it  disappeared,  is  now  quite  sound,  with  no  return 
for  five  years  and  no  necessity  for  wearing  a  truss.  This  is, 
however,  far  from  being  a  typical  case,  for  strangulation  may 
occur  at  any  time,  and  forms  a  constant  menace. 

Ml  hernias  should,  of  ci.urse.  be  reduced  and  retained,  prefer- 
ably, by  a  truss  that  docs  not  present  a  convexity  of  surface  great 
enough  to  enter  and  spread  the  abdominal  ring.  The  flat  pad 
described  by  Jay  \V.  Scaver  (Fig.  ;,25)  is  comfortable  to  the  patient, 
ran  be  kept  dean  at  all  times,  andean  Ijc  worn  in  the  water  with- 
out damage.    It  is  especially  suitable  for  young  men.    It  con- 


366 


EXERCISE    IN    EDUCATION    AND    MEDICINE 


sists  of  a  small  steel  band,  covere<l  with  vulcanized  rubber,  and 
a  hollow  rubber  pad  two  inches  in  diameter  as  the  support. 

In  a  recent  hernia,  where  pain  is  present,  the  patient  should 
remain  quiet  for  a  weelc  or  two,  to  get  accustomed  to  the  feel  of  the 
truss,  and  should  then  begin  a  course  of  light  work  for  the 
abdominal  muscles,  as  well  as  more  general  exercise  for  the  whole 
muscular  system.  These  exercises  should  be  done  daily  and 
should  be  increased  in  number,  complexity,  and  resistance. 

Great  stress  should  be  laid  on  teaching  control  of  the  abdominal 
muscles  by  forced  breathing  and  aklominal  exercises.  The 
extent  to  which  s|)ecialization  and  rhythmic  contraction  of  these 
muscles  can  be  carried  is  shown  in  the  movements  of  the  Oriental 
(lansc  (III  Vmlri:  .\s  the  strength  and  control  of  the  abdominal 
muscle  increases,  the  worlc  is  intensified  and  extended.  Seaver 
allows  his  patients  the  most  trying  gymnastic  feats,  such  as  the 
layout  on  the  horizontal  bar.  The  movements  must  be  varied. 
Such  a  movement  as  lying  on  the  back  and  raising  both  legs  to  a 
perpendicular  position  does  not  i)roduce  the  desired  result,  as  the 
strain  falls  chiefly  on  the  rectus  abdominis  and  psoas  muscles. 

The  most  effective  movements  are  those  in  which  flexion  of  the 
trunk  is  accompanied  by  side-twisting.  Great  stress  should  lie 
laid  on  the  deepening  and  raising  of  the  chest,  thus  drawing  up  the 
abdominal  contents,  and  relieving  the  downward  thrust  of  the 
thorax  and  upper  abdominal  structures. 

During  exercise  the  aljdominal  rings  should  be  protected  by  the 
truss  or  by  the  finger  placed  so  as  to  keep  u]i  a  continuous  ])ressure. 

.\  day's  work  should  begin  with  Exercises  Xos.  I,  II,  ami  IV, 
recommended  for  the  development  of  thoracic  and  abdominal 
breathing,  and  then  the  following  movements  should  be  introduced : 

Exercise  /.—Patient  lying  on  the  Ijack,  one  hand  behind 
the  neck.  The  other  placed  so  that  llie  middle  finger  covers 
the  inguinal  canal  and  external  ring  (Fig,  320).  Raise  the  head 
and  shoulders,  twisting  to  the  right  for  a  hernia  of  the  left  side. 
Repeat  twenty  timt->  without  holding  the  breath.  In  a  double 
hernia  both  hands  should  co\er  the  abdominal  ring  and  the 
twisting  should  be  to  alternate  sides. 


OTHER     DISORDERS    OF    NUTRITION 


367 


Fig   336. 


Exercise  //.—Patient  stanilinn,  hands  clasped  behind  the  head. 
Trunk  circumduction  to  the  right  (Fig.  327),  bacliward  (Fig.  328), 


Fig.  317. 


to    the    left   and    forward    (Fig.    329).     Repeat    fue   times  and 
reverse   up   to  twenty   times.     The  breath  should  not  be  held 


3« 


KXeCCIgE  IN  EDUCATION   AND  MEDICINE 


during  this  exercise  anrl  the   hernia  should  be  kept   up  by  the 
truss. 

This  movement  brings  into  action  all  the  abdominal  muscles, 
and  keeps  the  chest  in  the  best  possible  position. 


Fig.  399. 


Exercise  III. — Patient  seated,  facing  stall  bars,  feet  fixed, 
hands  on  the  hips,  with  fingers  over  the  ring.  Backward  bending 
and  twisting  to  the  right  and  to  the  left  alternately,  without  holding 
the  breath.     Repeat  twenty  times. 

This  brings  in  all  the  abdominal  muscles,  the  lateral  twisting 
especially  causing  a  powerful  action  of  the  obliques.  It  may  be 
modified  by  placing  the  hands  behind  the  head  (Fig.  ^30)  after 
the  muscles  have  been  developed  enough  to  stand  ii,  the  truss 
being  in  place. 

The  nautical  wheel  is  a  valuable  piece  of  apparatus  in  the 
treatment  of  this  condition  (Fig.  34).  as  are  all  the  lateral  trunk 
movements  of  the  Swedish  gymnastics. 

Massage  with  the  finger-tips,  consisting  of  kneading  and 
petrissage,  should  be  used  over  the  abdominal  rings  at  the  end  of 
each  treatment,  to  stimulate  the  local  circulation  and  promote  their 
contraction. 


OTHER   OlSOKDERS   OF   NlTRinON 


369 


Under  this  (Itvelopmenial  treatment,  Seaver  rc|)orts  that  over 
70  per  cent,  of  his  cases  have  been  relieved  of  the  necessity  of 
wearing  a  truss  of  any  kind,  and  my  cxiierience  would  confirm 
his  observations. 

I  have  also  seen  the  greater!  Ijcnefil  resulting  from  it  in  men  up 
to  fifty-five  fears  of  age,  the  general  improiemcnt  in  tone  of  the 
»Wo«inal  muscles  awl  reiki  Inam  the  consunt  pain  and  dragging 


^iK-  .1,10. 


sensation  being  complete,  while  the  muscles  acquire  an  alertness 
in  contraction  that  prevents  their  being  taken  by  suqjrise  by  an 
unexpected  movement  or  strain. 

it  is  frequently  due  to  the  sluggish  and  ineflfective  action  of 
these  neglected  muscles  that  hernia  is  alIowe<l  in  the  first  place, 
and  their  education  and  development  form  the  best  protection 
against  its  return. 


CHAPTER   XXIII 

EXERaSE  IN  THE  TREATMENT  OF  NERVOUS 
DISEASES 

Massac-  jchanical  vibration,  and  active  exercise  influence 
disorders  ot  he  nervous  system  through  their  power  to  control 
pain,  to  improve  the  nutrition  of  the  atTected  region  or  the  general 
health  of  the  patient,  and  to  reeducate  disordered  or  impaired 
coar^natirai. 


muMmuLicmY  cammass  of  nerves 

In  acute  intlammation  of  the  mucot^  membranes  of  the  throat 
and  lungs  or  of  the  abdominal  organs,  points  painful  to  pressure 
arc  found  along  the  spine,  at  the  level  from  which  the  sympathetic 
ner\'e-supply  of  those  areas  or  organs  is  derived. 

.According  to  Lightner  Witmer,'  the  evidence  seems  to  point 
to  certain  tracts  in  the  spinal  cord  possessing  a  specific  pain 
function.  These  are  situated  a  short  distance  above  the  segment 
of  the  cord  that  receives  the  peripheral  nerves.  The  viscera  refer 
their  pain  to  this  pain-organ  of  the  spinal  cord  through  the  ^'ympa- 
thetic  nerves,  which  communicate  with  the  spinal  nerves  before 
entering  the  cord  itself. 

The  application  of  massage  or  vibration  over  these  painful 
points,  which  mark  the  posterior  primary  divisions  of  the  cervical 
or  dorsal  nerves,  is  generally  followed  by  temporary  relief  of  the 
symptoms.  This  pain-organ  is  anesthetized,  or  at  least  for  the 
time  being  its  capacitv*  for  feeling  pain  is  exhausted.  The  points 
at  which  this  stimulation  should  be  applied  and  its  amount  and 
nature  have  already  been  described  in  the  chapter  an  Mechanical 
Massage. 

'"Twentieth  Century  Practice  of  Medicine."  xi,  i^s,  45. 


XXUCISE   IN    THE    IMAIMENT   OF   Nli«V0U8   DISEASES     37. 

Vibratfon  over  the  lower  lumbar  and  sacral  regions  for  inflam- 
mation of  the  sciatic  nerve  is  frtquenUy  foUowed  by  immediate 
relaxation  of  muscular  spasm. 

In  sciatic  neuritis  this  treatment  has  been  used  with  great 
success,  either  in  the  form  of  vibrations,  as  described  above  or 
after  the  method  of  A.  Symonds  Eccles,  who  starts  with  two  .laily 
treatments  of  fire  or  ten  minutes  alter  the  first  few  days  of 
the  disease,  gradually  increasing  them  to  twenty  minutes  each 
He  uses  friction  and  kneading  directly  along  the  course  of  the 
ward*  ""^  '"  ^'"^*^'  "^Kilning  at  the  heel  and  working  up- 

Before  giving  a  prognosis  or  undertaking  treatment  the  diagno- 
sis between  neuritis  and  rheumatism  should  Ijc  made. 

-Muscular  rheumatism  is  aggravat.-d  by  motion  and  relieved 
by  rest  and  warmth,  whereas  in  a  tru.-  neuritis  the  pain  is  worse  at 
night,  while  the  [atient  is  warm  and  at  rest,  and  wears  off  when  he 
IS  up  and  moving  about. 

The  relief  from  discomfort  and  the  freedom  of  motion  experi- 
enced after  each  massage  are  great,  although  they  may  Ik-  but  tem- 
porary, and  repeate<l  massage  extending  throughout  the  necessarily 
slow  recovery-  increases  materially  the  patient's  comfort.     In  the 
later  stages,  when  the  pain  is  almost  gone  and  stimulation  is  welf 
borne,  hacking  m«-cments  and  deep  vibration  are  added.     Passive 
movement>s  in  which  the  thigh  is  flexed,  the  knee-joint  being  kept  " 
in  extension,  stretch  the  nerve  and  frequently  give  relief-  and 
hnally,  toward  the  end  of  the  treatment,  active  movements  are 
of  value  m  counteracting  the  atrophy  that  results  from  inaction  and 
the  disease  itself. 

Graham  deprecates  the  use  of  massage  over  the  sciatic  nerve, 
and  confines  his  manipulations  to  the  muscle  masses  of  the  front 
and  sides  of  the  thigh,  with  gende  stroking  only  on  the  posterior 
aspect  of  the  limb.  Where  hacking  and  percussion  are  used  the 
movements  should  be  genUe,  and  any  increase  in  the  pain  after 
massage  should  be  a  sign  to  desist. 

Massage  is  not  well  borne  in  brachial  neuritis,  especially  during 
the  aciien.5ss  of  the  attack,  and  absolute  rest  isAen  essential. 


37» 


IXEICISE  IN   EDUCATION   AND   MEDICINE 


Only  in  the  later  stages  may  it  be  employed,  and  then  with  pre- 
cautions to  avoid  a  reawakening  of  the  inflammatory  process. 

Balfour,  of  Edinburgh,  employed  [lercussion  and  compression 
for  neuralgia  in  1819. 

Kccles  reports  relief  by  local  massage  of  intercostal  neuralgia 
and  neuralgia  of  the  cervicobrachial  nerves.  In  the  trifacial  and 
occipital  forms  relief  is  sometimes  afforded  by  gentle  [lercussion 
and  kneading  of  the  scalp  and  face  over  the  seat  of  pain. 

The  improvement  in  the  circulation  and  the  elevation  of  the 
subnormal  local  temperature  by  the  warmth  of  the  hand  during 
massage  are  doubtless  contributory  causes  to  the  relief  of  theie 
symptoms.  , 

Nerve  excitation  and  vibration  for  the  relief  of  pain  by  means 
of  percussion  became  of  great  interest  and  importance  as  a  result 
of  Dr.  J.  Mortimer  Granville's  experiments  in  London. 

Acute  pain  he  likened  to  a  high  note  in  music,  produced  by 
rapid  vibrations.  Dull  aching  pain  he  likened  to  low  notes, 
caused  by  slow  vibrations.  He  attempted  to  bring  discord  into 
the  rhythm  of  morbid  vibrations,  and  so  relieve  or  cure  the  neuralgia 
by  his  instrument,  the  "percutor,"  in  which  the  rate  of  blows 
could  be  changed  at  will,  and  the  modem  vibrator  is  but  a  modifi- 
cation of  his  instrument. 

OCCUPATION  NEUROSES 

Scrivener's  palsy  has  become  comparatively  rare  with  the 
increased  use  of  the  typewriter,  but  exhaustion  neuroses  are 
frequent  amonp  piano-players  and  violinists,  baseball-pitchers,  and 
telegraph  operato.s. 

While  no  aiorbid  anatomic  change  can  be  made  out,  this 
trouble  appears  to  be  the  result  of  an  exhaustion  or  overexcitability 
of  the  centers  controlling  the  muscular  movements  most  involved. 
The  symptoms  are  cramps  and  spasms  of  the  muscles,  weakness 
and  debility,  extending  even  to  paralysis,  tremors,  a  feeling  of  great 
tiredness,  with  acute  shooting  pains,  and  sometimes  a  subacute 
neuritis,  with  pain,  numbness,  or  tingling  in  the  fingers.  These 
conditions  run  at  best  a  chronic  course,  which  can  be  greatly 


IXnau  IN  IHI  TKEATKENT  Of  NUVOUl  OtSEASU     373 

•hortened  if  perfect  rest  from  the  habitual  mmement  and  daily 
manage  and  manipulation,  with  simple  gymnastics,  be  applied. 

In  one  of  my  cases,  a  violinist,  a  nen'ous  girl  of  fourteen,  with 
fatigue  pains  coming  on  rapiilly  and  numbness  of  the  third  and 
fourth  lingers  of  the  left  hand,  a  daily  course  of  massage,  con- 
sisting of  friction  and  kneading  of  the  fingers  and  small  muscles  of 
the  hand,  forearm,  arm,  and  shoulder,  accompanied  by  manipu- 
lation of  the  joints  separately  and  a  few  simple  gymnastic 
exercises  for  the  fingers  separately  and  together,  brought  about 
a  complete  recovery  in  about  two  months,  enabling  her  to 
resume  her  study.  This  is  an  unusually  favorable  result,  and 
under  the  best  of  conditions  the  tendency  to  rela|)sc  must  be  kept 
in  mind. 

INFANTILE  PARALYSIS 

The  onset  of  this  disease  is  usually  without  warning,  beginning 
with  vomiting  and  fever,  and  the  paralysis  may  often  be  found  the 
next  morning,  but  usually  comes  on  from  two  to  four  days  after- 
ward. Sometimes  it  is  not  noted  for  a  week  or  ten  days.  It  is 
accompanied  by  rapid  wasting  of  the  muscles,  which,  however, 
may  be  obscured  by  the  presence  of  fat.  Sooner  or  later  contrac- 
tures develop,  causing  eversion  or  inversion  of  the  foot,  o\  erexten- 
sion  or  flexion  at  the  ankle,  while  dangle  foot  is  present  after 
complete  paralysis  of  all  the  muscles. 

There  may  be  overextension  of  the  knees  or  relaxation  of  the 
abdominal  walls,  simulating  hernia;  the  scapute  may  be  winged 
as  a  result  of  paralysis  of  the  serratus,  and  the  unbalanced  actions 
of  the  arm  and  hand  muscles  may  produce  marked  deformities. 

The  paralysis  is  characteristically  random  in  its  distribution 
(Gowers),  but  the  following  table  shows  the  most  frequent  combi- 
nations of  regions  involved. 


"lOOCOn  WSOWTION   IBT  CH*n 

(ANSI  ond  ISO  reSI  CHAUT  No.  2) 


III— 

la  12.8      12J 

5     laia    |M 

:?itt  ■— 

llli 

IIS 

I^U& 

jS 


A     APPLIED  IN/MGE    Ine 


374  EXERCISE   IN    EDUCATION   /*ND   MEDICINE 

TABLE    SHOWIXd    DISTRIBITIOX   OF   PAKALVSIS 

Dudieiine.  Sceli|,'mullcr.  SinkU-r.  Slarr.  Macl'hail.  Total 

B<»th  legs Q  ,4  ,0;  40           45  -'15 

R'Sht  leg .5  15  03  20             y  i,v 

Left  leg 7  27  6.'  27            20  143 

Right  arm 5  9  5  7            ^  ^q 

Left  arm 5  4  s  4            2  23 

Both  arms j  i  1  2             2  S 

All  extremities 5  2  t^-  5            4  ^1 

Arm  and  k-g,  same  side  .    ,  [  2  21  411  44 

Arm  and  leg,  oiiposiie  sidi-  1  2  1408 

Trunk i  o  22  3            o  26 

Three  cxlremilies o  o  10  2            2  14 

Total 02  75  340  liS          99  694 

The  groups  in\olved  may  be  discovered  by  the  wasting,  by 
electric  stimulation,  and  by  careful  examination  of  the  actions  that 
are  imperfect  or  absent.  The  voluntary  movement  present  must 
be  estimated  with  great  accuracy,  and  the  difficulty  of  this  has  been 
iiisisted  upon  by  Becvor,  in  his  Croonian  Lectures  on  Muscular 
Movements  (1903). 


Fig-  33 '  —Incorrect  position  for  test- 
ing thp  action  of  the  triceiJs. 


Fig.  33J. — Correct  position  for  te.iting  the 
action  of  the  triceps. 


Among  the  fallacies  that  may  occur  are  the  confusing  of  the 
action  of  gravity  for  muscular  action.  A  slow  relaxation  of  the 
active  biceps  may  be  vonfounded  with  contraction  of  the  triceps 


EXEKCISE    IN   THE   TREATMENT   OF   NERVOUS   DISEASES     375 

When  the  bent  arm  is  slowly  straightened  when  hansing  at  the 
sKle  whereas  ,f  the  arm  be  first  Hexed  and  the  elbow  be  held  at 
the  leve  of  the  shoulder  and  the  patient  told  to  extend  it,  he  will 
be  unable  to  do  so  (Figs.  331  and  332\ 

Another  error  that  must  be  guarded  against  is  the  cre.liting 
of  a  muscle  with  contractile  power  when  the  movement  is  the 


Fig.  J33— Correct   posilion   for  testing   the  anion  of  the  fl„ors  of  ,hc  dl«,„       The 
swinging  of  the  arm  is  thus  prcventc<l. 

result  of  the  action  of  accessory  muscles.  In  Hexing  the  arm  where 
the  bfceps  ,s  affected,  the  contraction  of  the  supinator  longus  and 
brachialfs  ant.cus  may  disguise  the  true  lesion.  The  habit  that 
patients  acquire  of  jerking  the  arm  or  leg  upv.ar.l  or  forward  and 
so  simulating  the  movement  of  muscles  which  are  actually  inert 
must  also  be  detected  (Fig.  333).  ' 


376 


EXERCISE    IN    EDUCATION    AND   MEDICINE 


These  fallacies  should  be  demonstrated  to  patients  in  order 
that  they  may  not  be  deceived  as  to  the  actual  condition  present. 

The  outlook  for  complete  recovery  of  a  group  long  paralyzed 
is  bad,  but  a  gradual  restoration  of  power  may  go  on  throughout 
several  years,  and  Jacob  Bolin  reports  the  return  of  contractility 
after  ten  or  twelve  years.  If  these  cases  are  neglected,  however, 
the  atrophy  becomes  extreme,  the  growth  of  the  bones  is  retarded, 
and  unopposed  active  muscles  contract  and  produce  deformities. 

Treatment  may  be  begun  as  soon  as  the  child  can  bear  friction 
Df  the  affected  part. 

It  should  consist  of  massage  of  the  affected  regior  from  the 
periphery  to  the  center,  friction  with  deep  kneading,  and  stroking 
to  increase  the  circulation,  which  is  always  defective,  as  shown 
by  the  constant  subnormal  temperature. 

A  splint  may  be  necessary  to  prevent  overstretching  of  the 
paralyzed  muscles  from  the  unopposed  action  of  their  uninjured 
antagonists.  Whenever  any  voluntary  action  remains  in  the 
affected  muscles,  it  should  be  carefully  fostered  by  gymnastic 
exercises,  to  train  the  patient's  will-power  and  concentration. 

Every  means  must  be  used  to  maintain  the  nutrition  of  the 
muscles,  so  that  recovery  of  the  injured  centers  in  the  cord 
may  find  well-nourished  muscular  tissue  on  which  to  act.  Flan- 
nel bandages  or  a  covering  of  rabbit  skin  should  be  kept  on  the 
limb,  so  that  its  temperature  may  be  continually  kept  equal  to 
or  above  its  fellow,  and  the  muscles,  bones,  and  joints  given 
the  increased  blood-supply. 

The  technic  of  massage  may  be  taught  to  the  mother  or  nurse, 
to  be  continued  daily  at  home,  in  addition  to  the  less  effective 
stimulation  by  electricity,  and  it  should  be  persisted  in  throughout 
the  entire  period  of  growth,  where  necessary,  accompanied  by 
frequent  examinations  and  measurements. 


NEURASTHEMA 
Hysteria  and  neurasthenia  require  massage  and  resistance 
movements  for  their  complete  management.    In  Weir  Mitchell's 
treatment  for  these  affections  he  first  counteracts  the  evil  effects 


I 


i 


EXERCISE   IN    THE    TREATMENT   OF  NERVOl'S    DISEASES     377 

on  the  digestion  of  overfeeding  and  continual  rest  in  bed  by  massage 
and  gymnastic  movements,  to  reaccustom  the  patient  graduaUy 
to  the  muscular  tasks  of  daily  life. 

His  custom  is  to  begin  with  a  general  massage  after  the  first 
few  days  of  milk  diet,  the  hour  chosen  being  midway  between  two 
meals,  the  patient  remaining  in  bed.  The  oi«;rator  starts  with 
the  feet,  continues  the  manipulations  up  each  leg,  then  to  the 
muscles  of  the  loins,  spine,  abdomen,  and  chest.  The  order  of 
movements  is  described  in  the  chapter  on  Massage.  The  entire 
treatment  lasts  about  half  an  hour,  and  is  gradually  increased  up 
to  one  hour,  followed  by  an  hour  of  rest.  This  is  continued  for 
at  least  six  weeks,  and  then  half  an  hour  is  devoted  to  massage 
and  the  other  half  to  movements  of  flexion  and  extension  of  the 
limbs  and  trunk,  with  resistance.  In  the  less  severe  cases  confi- 
dence is  put  in  the  more  active  forms  of  exercise.  One  young 
man  referred  to  me  by  him  began  by  wrestling  exercises  in 
which  at  first  he  did  little  more  than  gently  resist  the  various 
positions,  locks,  and  throws.  The  resistance  gradually  in- 
creased in  force  and  duraf  until,  at  the  end  of  three 
months,  he  had  gained  sixte.  ,  pounds  in  weight  and  had 
improved  so  much  in  strength,  courage,  and  vigor  that  he 
J-as  sent  home  cured.  Other  cases  derive  the  greatest  benefit 
from  an  active  outdoor  life,  in  which  camping,  swimming,  walking, 
riding,  and  wrestling  form  a  great  part  of  the  day's  program. 

Exercise  hould  be  made  as  simple  and  interesting  as  [xjssible, 
the  obiect  being  to  improve  the  nutrition  to  the  utmost  without 
und  -hausting  the  attention  or  overtaxing  the  coordination. 
For  reason  exercise  demanding  skill  and  concentration,  like 
fencing,  should  be  avoided. 

STAMMERING 
Exercises  of  skill  are  employed  almost  exclusively  to  correct 
such  disordered  coordinations  as  stammering  and  stuttering, 
where  the  utterance  of  intelligible  speech  is  hindered  or  prevented 
by  convulsive  and  disorderly  contraction  of  the  muscles  of  respiia- 
tion,  phonation,  or  articulation. 


378 


EXERCISE    IN    EDl'CATION    AND    MEDICINE 


Stammering  occurs  in  alrout  i  jjer  cent,  of  school  children. 
Although  accurate  statistics  are  hard  to  get,  the  Germans  show- 
about  I  22  per  cent,  in  the  schools,  whereas  Hartwell's  s,tatistics 
show  about  0.78  (>er  cent,  among  the  children  of  Boston. 

Stammering  is  exceedingly  contagious  in  a  class,  and  rapidly 
spreads  among  school-children,  making  schools,  according  to 
Melville  Bell,  veritable  nurseries  of  stuttering. 

It  has  been  attributed  to  the  forcing  of  their  education  before 
the  brain  is  sufficiently  developed  to  govern  the  power  of  vocal 
utterance,  so  that  a  course  of  treatment  would  begin  with  gymnas- 
tic exercises,  such  as  described  in  Chapter  XIV,  for  the  breathing 
muscles,  the  first  to  function  in  the  development  of  the  child, 
while,  later  on,  the  muscles  of  phonation,  and,  lastly,  those  of 


Fig.  3,14- — The  points  of  contact  between  the  tongue  and   palate  in   the  formation  of 
the  nounds  I.,  R,  and  K  (G,  Hudson  Makuen). 

articulation,  are  trained.  Treatment  wr  ild  tbr.s  be  based  on  the 
preliminary  developmert  of  the  fundamental  and  intermediate 
mechanisms,  ending  with  the  finest  and  most  specialized  coordina- 
tions. 

Audible  speech  is  caused  by  the  blast  of  air  driven  from  the 
lungs  by  the  muscles  of  expiration  through  the  slit  of  the  glottis, 
bounded  by  the  vocal  cords,  whose  approximation  is  varied  by  the 
laryngeal  muscles,  into  the  mouth,  where  it  is  formed  and  modified 
by  the  muscles  of  the  palate,  tongue,  and  lips.  The  complete 
production  of  speech,  then,  is  eflfected  by  a  coordination  of  muscles 
in  the  chest,  throat,  and  mouth  respectively. 

Hudson  Makuen  lays  special  emphasis  on  the  difference 
between  ordinary  passive  breathing  and  the  breathing  of  voice 
production,  or  "artistic  breathing,"  the  function  of  passive  breath- 


EXEKCISE    IN    THE    TKEATMEST    OF    NFRVOIS    DISEASES     J79 

ing  being  simply  to  aerate  the  blood  and  eliminate  waste-matter, 
while  breathing  for  voice  production  is  to  set  the  machinery  of  the 
voice  in  motion  and  to  control  this  motion  as  a  definite  voluntary 
muscular  process. 

The  first  muscular  act  in  breathing  for  voice  ■'ro<luction  is  a 
slight  inhalation,  putting  the  res))iratory  muscles  and  the  thorax 
into  an  active  [)osition.  He  finds  that  nearly  all  s|)ecch  defectives 
fail  at  this  [mint. 

When  this  is  done  properly,  the  column  of  breath  raised  ujjon 
the  diaphragm  is  ready  for  its  impact  against  the  vocal  cords— an 
impact  which  must  be  made  with  the  greatest  nicety  anil  control. 
This  movement  of  expiration  for  voice  production  he  attributes 
to  the  depression  of  the  lower  ribs  by  the  diaphragm— a  muscle  of 


I<  B  K  and  Q 

^'K-  335— The   position   of  the   tongue  in   producing   th(    sounds   L,   R,  and  K  (G. 
Hudson  Makuen). 

inspiration  in  ordinary  respiration,  whereas  in  the  "artistic  " 
breathing  needful  in  voice  production  it  becomes  a  muscle  of  ex- 
piration, not  only  by  preventing  the  pulling  up  of  the  ribs,  but  by 
pulling  them  downward  and  inward.  Proper  coordination  of  the 
intercostal  and  abdominal  mu.scles  in  addition  to  litis  action  of  the 
diaphragm  is,  of  course,  essential  to  the  production  of  good  tone. 
Treatment  of  stammering  would  then  be  begun  by  the  training 
of  this  res[)iratory  coordination  by  itself,  which  is  done  by  articu- 
lating a  series  of  syllables,  using  for  each  a  single  expiratory  effort. 
The  muscles  that  control  the  vocal  cords  are  also  trained  by 
exercises;  and  the  coordination  between  the  muscles  of  expiration 
and  the  larygneal  muscles  are  then  trained  to  act  together,  since 
many  stammerers  vocalize  at  the  wrong  time,  there  being  no  column 
of  air  ready  when  the  cords  are  in  the  right  position,  or  vice  versa. 


380 


EXERCISE   IN   EDUCAnoN   AND  MEDICINE 


\h 


The  pharynx,  the  pa  ite,  the  tongue,  and  the  lips,  organs  of 
articulation  which  mold  the  voice  into  speech,  are  also  controlled 
by  voluntary  muscles.  Where  there  is  any  organic  defect  in  them, 
such  as  shortening  of  the  muscular  fibers,  cleft  palate,  or  harelip, 
this  must  be  corrected,  and  the  rest  becomes  a  purely  educational 
process. 

Care  must  be  taken  to  distinguish  between  lack  of  development, 
faulty  habits,  and  disease  in  the  speech  center  of  the  brain,  for  in 
the  last  cla.ss  of  cases  the  ouUook  is  hopeless. 

The  entire  treatment  of  functional  stammering  and  stuttering 
is  based  on  the  physical  training  and  coordination  of  the  mechan- 
isms of  speech,  the  proper  use  of  the  muscles  of  respiration  with 
reference  to  voice  production,  the  training  of  the  vocal  muscles, 
and  the  education  of  the  muscles  of  articulation. 

Exercises  are  given  to  instruct  the  patient  in  the  elementary 
sounds  of  the  language,  how  to  shape  the  lips,  or  where  the  tongue 
is  to  be  placed,  and  this  training  requires  patience  and  perse- 
verance until  the  defect  is  finally  overcome. 

The  success  that  has  attended  Makuen's  clinic  on  speech 
defectives  is  in  great  part  due  to  the  care  with  which  the  breathing 
and  vocal  exercises  are  graded,  and  the  excellence  of  his  discipline 
in  inforcing  their  accurate,  thorough,  and  persistent  practice. 

The  high-pitched,  falsetto,  or  eunuchoid  voice,  which  occa- 
sionally occurs  in  men  otherwise  normal,  can  be  corrected,  accord- 
ing to  E.  E.  Clark,'  by  a  course  of  vocal  gymnastics  and  singing 
exercises,  beginning  with  a  note  of  high  pitch  and  then  singing 
down  the  scale  until  the  lowest  possible  note  on  the  register  is 
reached.  The  voice  is  then  kept  at  this  pitch,  and  the  low  notes 
are  repeated  ten  or  fifteen  times.  The  patient  is  then  taught  to 
read  aloud  in  the  deep  tone  secured  by  singing  his  way  down  the 
scale.  Makuen  secures  the  same  result  by  training  the  patient 
to  lower  the  position  of  the  larynx  during  phonation. 
CHOREA 

Chorea  is  a  disturbance  of  coordination  characterized  by 
irregular  involuntary  contraction  of  the  muscles,  accompanied  by 

'  "  Medical  Fortnightly,"  St.  Louis. 


EXERCISE   IS   THE   TREATMENT   OP   NERVOUS   DISEASES 


381 


psychic  disturbances,  found  mostly  in  young  children,  the  pro[x)r- 
tion  of  girls  tf  Iioys  being  j  to  i. 

It  occurs  especially  in  abnormally  bright,  active-minded 
children,  who  are  forced  ahead  of  their  grade  in  school,  and  arc 
subject  to  the  excitement  of  com[)ctition  for  prizes.  While  there 
arc  no  constant  anatomic  changes  found  in  the  nervous  system 
after  death,  the  tendency  to  endocarditis  is  such  that  in  iio'cases 
of  autopsy  the  eCecla  were  noted  in  nearly  100. 

The  duration  of  an  attacl<  is  very  variable— from  two  to  three 
weelis  to  the  same  number  of  months— with  an  average  of  about 
eight  or  ten  weeks. 

Because  of  this  great  liability  to  endocarditis  the  heart  should 
be  carefully  examined  in  all  cases.  The  presence  of  a  murmur 
alone  does  not  indicate  endocarditis,  since  the  disease  occurs  most 
frequently  in  nervous  young  girls  in  whom  heart  murmurs  are 
almost  the  rule.  If  the  apex  is  in  the  normal  position  and  the  area 
of  dulnesf,  is  not  increased  vertically  or  to  the  right  of  the  sternum, 
there  is  probably  no  serious  valvular  disease. 

The  treatment  of  the  acute  attack  consists  of  rest,  isolation, 
and  tonics.  Where  the  jerky  movements  have  abated,  the  appli- 
cation of  general  massage  is  of  value,  and  the  importance  of 
gymnastic  exercise  cannot  be  overestim,  ted  during  convalescence. 
When  the  acuteness  of  the  attack  has  subsided,  the  treatment 
should  be  begun  with  massage  for  the  first  few  days,  followed  by 
simple,  slow,  lesisted  movements,  and  later  on  by  rhythmic 
exercises  sufficiently  active  to  tire  the  muscular  system  moderately. 
This  should  be  done  with  the  patient  by  herself  if  possible,  and 
any  excitement  or  competition  of  class  drills  should  be  sedulously 
avoided. 

The  keynote  of  such  treatment  is  the  rhythmic  repetition  of 
simple  movements  to  overcome  the  irregularity  of  the  twitchings, 
and  great  strain  or  fatigue  on  the  attention  of  the  patient  should 
be  eschewed. 

The  practice  of  simple  dancing  exercises  to  music  is  of  the 
utmost  service,  emphasizing  the  rhythm  and  taking  away  the 
mental  strain  necessary  to  follow  movements  done  to  command. 


CHAPTER  XXIV 

THE  TREATMENT  OF  LOCOMOTOR  ATAXIA  BY 
EXEROSE 


Locomotor  ataxia,  or  tabes  dorsalis,  is  a  degeneration  of  tlie 
posterior  rcxits  and  columns  of  the  spinal  cord,  produced  by 
exfjosure  to  cold,  syphilis,  or  some  other  acute  [misoning  of  the 
nerve  tissue. 

In  reading  the  literature  of  the  subject  one  is  struck  by  the 
multitude  of  theories  and  the  inadequacy  of  any  one  of  them  to 
explain  many  of  the  symptoms. 

The  hyjiothesis  that  is  of  most  interest  in  connection  with  the 
application  of  exercise  is  that  of  Edinger,  called  the  "  exhaustion 
theory,"  in  which  he  believes  that  the  cells  of  the  body  are  normally 
in  a  state  of  equilibrium,  one  with  the  other,  so  that  if  a  cell  be- 
comes weakened  by  disease,  other  cells  lying  beneath  it  will  crush 
it  out  in  their  growth,  .\gain,  when  the  amount  of  work  required 
from  a  group  of  cells  is  too  great,  even  if  their  vitality  be  perfectly 
normal,  they  may  succumb  simply  from  their  inability  to  recuiier- 
ate  and  regain  the  loss  of  tissue  due  to  their  excessive  activity. 
A  similar  condition  is  found  in  occupation  palsies.  The  nutrition 
of  the  cells  may  be  impaired  through  toxins  circulating  in  the 
blood,  especially  if  they  have  a  selective  action  on  certain  parts  of 
the  nervous  system;  and  nearly  go  per  cent,  of  tabetic  patients 
show  a  history  of  syphilis. 

The  exhaustion  theory  would  help  to  explain  the  frequency  of 
the  first  appearance  of  ataxia  in  the  lower  extremities,  the  neurons 
governing  them  being  constantly  employed  in  the  maintenance  of 
equilibrium. 

Cases  may  be  cited  where  ataxia  has  first  appeared  in  the  arms, 
owing  to  overfunctioning.    One  case  reported  by  Mott  occurred 

3«» 


THE    HEATMENT   OF    LDCDMOTOR    ATAXIA    BY    KXERCISE     j8j 

in  a  mountcil  |joliiiman  in  whom  the  symptoms  starti-il  in  the 
arm  with  which  hf  held  his  horse's  reins. 

In  talxs  the  sensory  nerve-  are  -.Iso  afTecteii,  and  the  eyes  show 
a  characteristic  •)i,tic  atrophy  with  the  ArKyil-Rohertson  pupil 
Men  U'int?  mou  qjosiil  to  these'  tuti){ue  intluences  than  women, 
we  would  ex|)cc<  find  its  frequency  greater  amonK  iliem;  ami  the 
pro[jortion  is  actually  about  lo  to  i.  and  James  Stewart  has 
noted  'ts  freciucncy  among  lumlwrmen  who  have  liveil  a  hard  life 
in  the  logKinn  camps  during  the  winter  ami  spring  months. 

The  motor  symptoms  are  lirst  tiOticod  as  increased  clumsiness, 
especially  in  the  dark,  or  ilifiiculty  In  maintaining  the  e(|Hilil)rium 
when  washing  the  face  with  the  eyes  shut  i(Jsler).  When  the 
patient  stan-Js  with  feet  together  and  eyes  closed,  he  swavs  and 


Fig.  j36.-Hyi)olonia  ot  the  nusclra  ot  Ihe  ■»lvi,  .„d  ..pinal  column  (Frtnkcl 

may  even  fall  if  the  surgeon  docs  not  steady  him  (Romberg's 
symptom).  On  turning  quickly  he  is  apt  to  fall.  He  leans  upon 
a  stick  in  walking,  the  eyes  fixecl  on  the  ground,  the  Ixxly  thrown 
forward,  and  the  legs  wide  apart.  The  leg  is  thrown  out  violently 
the  foot  is  raised  too  high  and  is  brought  down  with  a  stamping 
movement  on  the  heel.  In  the  arms  it  may  be  first  noticed,  through 
his  difficulty  in  buttoning  his  collar  or  in  other  simple  acts. 

With  comparatively  advanced  ataxic  symptoms  he  shows  little 
alteration  in  the  size,  strength,  or  nourishment  of  the  muscular 
system,  ^'lerc  is,  however,  ahiays  present  in  a  typical  case, 
along  with  certain  se.isory  disti  rbances.  hyjwtonia,  or  lack  of 
muscular  tone,  which  allows  the  stretching  of  muscles  and  joints 
far  Ijeyond  their  normal  range  of  movement  (Frenkel).  This  may 
be  associated  with  flabbiness  of  the  muscles,  but  it  has  no  connec- 


3«4 


tXtRCISt   IN   EDICATION    AM)   SIEDICINE 


tion  with  Ihiir  actual  strtnuth,  which  is  seldom  im|>airc(l.'  The 
ataxic  symptoms  may  In:  classilicil  as— in)  Abnormally  rapid 
movcmi-nts;  [h)  exaxncratiil  muscular  fxcrti(m  in  |x;rformin^ 
simple  acli(ms;  d )  prolonKtil  contraction,  continuinn  after  the 
movement  has  la'en  c<>mpletc<l,  anil  id)  jerky  stacatto  progression. 

While  ataxia  is  the  only  symptom  that  can  he  rcacheil  hy 
exercise,  it  is  frequently  sufficient  to  keep  a  patient  l)edri(lden 
when  his  other  symptoms  arc  not  severe  enough  to  interfere  with 
his  rejjular  course  of  life. 

The  exerci «  treatment  is  liased  on  the  |)<>ssil)ility  of  educating 
the  impaired  cen:ral  nervous  system,  and  rcestablishint;  the  lost 
or  enfeebled  coordination  anil  sensibility.  The  symptoms  against 
which  it  is  ilirccted  is  a  motor  disturbance,  which  has  its  origin  not 
in  a  diminution  of  the  muscle's  motor  |iower,  but  in  a  loss  of 
sensibility  in  them,  and  it  is  based  on  the  capacity  of  the  neuro- 
muscular system  for  education  so  Ion;,'  as  the  motor  apparatus 
itself  is  intact.  It  consists  in  relearninj;  the  ordinary  movements, 
lost  in  consei|uence  of  a  partial  or  total  loss  of  sensibility,  a  task 
which  in  principle  is  identical  with  the  acijuisition  by  a  healthy 
person  of  a  complicated  feat  invob  in);  a  nice  adjustment  of  mus- 
cular action,  such  as  ju););lin);  or  balancinK.  Reliance  must  then 
be  placed  mainly  on  exercises  of  skill,  alternatinK  with  passive 
movements  and  mas.saj5e,  as  a  relief  to  improve  the  nourishment 
of  the  muscles  without  continuing  the  demand  on  the  rapidly 
tiring  will-|x>wer. 

The  exercise  jeatment  of  ataxia  has  been  pojjular  for  many 
years  in  Sweden,  and  was  used  forty  years  ago  in  America  by 
Dr.  Weir  Mitchell,  but  many  of  the  devices  employeil  have  been 
invented  by  Frenkel,  of  Heiden,  and  are  for  the  first  time  described 
in  his  work  on  tabetic  ataxia,  from  which  some  of  the  accompanying 
illustrations  are  taken. 

In  attempting  the  simple  movement  of  rising  from  a  chair  the 
tabetic  patient  usually  forgets  to  draw  the  feet  backward,  and  so 
finds  himself  unable  to  rise  without  assistance.  He  has  thus  to 
learn  this  simple  coordination  over  again. 

'  Frenkel,  p.  4f>. 


THE    TSEATULNT   OF    LIKOMIITOK    ATAXIA    IIV    I^AKRCrSK     J85 

Muvvmcnts  of  walking  (orwaril,  barkward,  anil  to  the  siilc, 
with  steps  of  measurt'il  distanci',  should  nuxt  h:  i>ractisfd.  For 
this  purixwc  the  ll<«)r  may  lie  |)aint<.il  with  l)laiK  lines  or  with 
fixit-prints  at  mcasuwl  distances  (Fi){.  337).  If  lines  \>c  drawn 
ziRzaK  on  the  floor,  their  continual  change  of  direction  makes  this 
walking  exercise  much  more  exacting  to  the  latient,  and  an 
irregular  |>attcrn  on  a  cariict  has  l)een  uscil  lor  this  |)ur|xMe. 


FiK-  ,1.17. 


When  these  simple  movements  ha\e  Ijeen  mastered,  walking 
up  and  down  stai/s  with  the  use  of  a  bannister  should  lie  practised. 
A  sjjecial  stairway  designed  Ijy  von  Leyflen  has  two  bannisters, 
and  the  stei)s  are  cut  so  that  the  foot  must  be  placed  down  accu- 
rately at  each  step  (Fig.  338). 

The  greatest  precautions  must  be  taken  to  prevent  the  patient 
from  falling  in  this  exercise  and  so  becoming  timid  or  discouraged. 
A  belt  with  a  handle  or  strap  attachment  should  be  placed  about 


386 


EXEKCISE  IN   EDUCAnON   AND   MEDICINE 


1% 


Fig,  338.— Dr.  von  Leyden's  stainvay  used  for  exercises  to  reeducate  the  lost  co- 
ordination in  locomotor  ataxia  cases  (Pennsylvania  Orthopedic  Institute  and  School 
of  Mechano-Therapy  (Inc.),  Phila.).     (Courtesy  of  Mr.  Max  J,  Walter.) 


Pig.  339- 

the  waist,  and  an  attendant  should  always  be  ready  to  catch  him 
if  he  shows  signs  of  losing  his  balance.    Exercise  of  the  lower 


THE    TREATMENT   OF   LOCOMOTOR    ATAXIA    BV    EXERCISE     387 

e^tremitfes  can  be  carried  on  in  bed,  where  the  disease  is  too  far 
advanced  to  permit  of  walking  or  standing.  He  is  told  to  touch 
the  great  toe  of  one  foot  with  the  heel  of  the  other  (Fig.  339)   then 


f'lR-   340 


to  run  the  heel  upward  along  the  front  of  the  shin  to  the  knee 
(Fig.  340),  and  back  again.     .Another  exercise  is  the  placing  of 


Fig.  341.— Notchfd  board  (Franktl). 


the  heel  of  either  foot  in  notches  cut  in  a  board,  as  shown  in  the 
illustration  (Fig.  341).     If  ,he  patient  be  seated  in  front  of  a  set 


388 


EXEKCISE  IN   EDUCATION   AND  MEDICINE 


]'(' 


of  movable  pins,  he  can  exercise  by  kicking  them  in  turn,  the 
attendant  naming  the  one  that  he  must  touch  with  his  foot  (Fig. 
342). 

Simple  movements  such  as  these  will  cause  rapid  exhaustion, 
and  the  pulse-rate  must  be  carefully  watched,  and  the  exercise 
stopped  short  of  fatigue. 


Fig.  343. — Dr.  von  Leyden's  ten-piti  amngement  used  lor  ttle  re-educstion  of  lost 
co-ordination  in  locomotor  ataxia  cases  (Pennsylvania  Orthopedic  Institute  and  Sctlool 
of  Mcchano-Ttierapy  (Inc.),  Phila.).     (Courtesy  of  Mr.  Max  J.  Walter.) 

The  upper  extremity  may  be  trained  by  taking  a  wooden 
block  about  eighteen  inches  long  and  triangular  in  section, 
so  prepared  that  one  edge  remains  sharp,  a  second  beveled 
off,  while  the  third  has  a  curved  groove.  The  block  is  placed 
on  a  table  in  front  of  the  patient,  in  a  position  indicated  by 
the  drawing  (Fig.  343),  with  the  grooved  edge  up.  He  is  requested 
to  draw  the  point  of  a  stout  pencil  or  pointer  along  the  groove  from 
the  farther  end  of  the  block  toward  him,  at  the  same  time  holding 


THE    TREATMENT   OF   LOCOMOTOR  ATAXIA   BY   EXERCISE     389 

his  fingers  and  wrist-joint  perfectly  stiff.  The  object  of  the 
exercise  is  to  teach  him  to  keep  his  arm  raised  in  a  definite  position, 
and  to  malte  simple  excursions  in  the  horizontal  plane. 

This  exercise  is  by  no  means  easy,  especially  when  the  pencil 
has  to  be  held  with  the  slightest  force.  .\t  first  it  will  often  leave 
the  groove,  but  with  practice  its  progress  becomes  more  steady, 
although  scarcely  ever  free  from  wabbling. 

It  is  usually  a  great  surprise  to  a  patient  on  his  first  exam- 
ination to  find  that  he  is  unable  to  place  his  finger  to  his  nose 


a= 


Fig-  ,143-— Triangle  block  for  the  hand  coonUnation  (Frenkcl). 

with  the  eyes  closed.  This  simple  exercise  may  be  practised  and 
varied  in  numerous  ways.  Frenkel  uses  a  perforated  board 
(Fig.  344),  the  tip  of  the  forefinger  being  placed  in  the  numbered 
hole  called  out  by  the  attendant.  It  can  be  made  more  difficult 
by  having  him  insert  pegs  into  the  holes. 

When  this  coordination  is  suflSciently  improved,  he  may 
advance  to  the  catching  of  colored  balls  swung  from  a  horizontal 
bar  and  caught  on  the  swing  (Fig.  345);  and  he  may  be  set  to 
copying  diagrams  with  a  pencil.    .As  soon  as  he  shows  signs  of 


390 


EXERCISE  IN   EDUCATION   AND  MEDICINE 


flagging  interest,  his  task  should  be  replaced  by  another  set  of 
exercises. 


Fig.  344. — Perforated  board  (Frenkel). 

Along   with   these   set   exercises   he   should    be    trained    in 
the  useful  operations  of  dressing  and  undressing  himself,  helping 


Fig.  345. — Colored  balls  swinging  (Frenkel). 


himself  at  the  tabk,  using  pen  and  ink,  and  other  procediures  that 
come  up  in  the  course  of  the  day. 


THE  TKEATMENT   OF   LOCOMOTOR   ATAXIA   BV   EXERCISE     391 

The  exercises  are  useful  only  when  the  attention  is  fully  con- 
centrated on  them.  This  necessity  for  concentration  and  the 
excessive  muscular  exertion  required  to  perform  simple  acts,  the 
fear  of  accidents,  and  the  annoyance  which  he  feels,  especially  at 
the  beginning  of  the  treatment  because  his  limbs  will  not  obey 
orders,  all  combine  to  produce  rapid  and  profound  fatigue,  and 
the  practice  of  any  movement  should  not  be  continued  for  longer 
than  three  or  four  minutes.  In  severe  cases,  where  nutrition  is 
impaired,  one-half  to  one  minute  will  be  quite  sufficient  until  he 
has  become  strong  enough  to  bear  the  strain  of  longer-continued 
practice  and  no  new  exercises  should  be  begun  until  there  is  com- 
plete recovery  from  the  excitement  and  fatigue  of  the  previous  one. 
Tabetic  patients  have  more  or  less  completely  lost  the  sense 
of  fatigue,  consequently  in  determining  whether  he  is  tired  or  not 
signs  of  inattention  and  the  rapid  action  of  the  heart  will  be  the 
most  relir-ble  guides.  The  pulse  usually  rises  to  120,  or  even  to 
160,  beats  a  minute,  in  direct  proportion  to  the  difficulty  of  the 
movement.  It  should  be  the  routine  practice,  therefore,  to 
examine  the  pulse  at  the  beginning  of  the  treatment  and  frequ.-nUy 
throughout  it,  and  to  interrupt  the  work  by  a  period  of  rest  as  soon 
as  the  pulse-beats  exceed  150. 

The  interval  of  rest  should  last  until  the  heart-rate  approaches 
normal  again,  although  in  most  cases  the  pulse  will  remain  a  trifle 
above  its  usual  rate.  If  it  becomes  unduly  frequent  after  slight 
exertion,  it  is  a  sure  sign  of  tabetic  cachexia,  and  such  patients 
must  be  treated  with  the  greatest  caution. 

The  exercises  are  for  coordination  and  not  to  increase  the 
muscular  power,  therefore  no  exercise  requiring  much  expenditure 
of  strength  is  of  projjortional  value  as  a  training  in  coordination, 
and  so  must  be  considered  harmful. 

Two  periods  of  exercise  a  day  arc  the  average  rule  of  practice. 
To  go  beyond  that  is  to  go  into  the  danger  zone,  unless  each 
stance  be  made  short,  and  the  patient  is  robust  and  determined 
to  make  rapid  progress,  in  which  case  three  periods  may  be  given. 
In  the  morning  he  takes  the  movements  designed  for  the  recumbent 
position,  which  are  the  easiest.    In  the  afternoon  he  may  have  fif- 


39a 


EXEKCISE  IN   EDUCATION   AND  MEDICINE 


teen  minutes  of  walking  exercise,  with  frequent  rests.  If  tlic 
amount  be  properly  regulated,  eaqh  successive  exercise  should  be 
followed  by  an  increase  in  control,  so  that  at  the  end  of  a  period 
he  should  feel  more  fresh  and  vigorous  than  before  starting.  It  is 
wise  in  some  cases  to  substitute  for  one  period  c  general  massage 
or  electric  treatment,  which  has  the  great  advantage  of  resting  the 
patient's  will  and  attention  and  improving  the  nutrition. 

The  unfailing  certainty  of  the  improvement  and  the  fact  that 
it  is  the  improvement  of  a  symptom  caused  by  an  organic  lesion 
attaches  unusual  interest  to  this  treatment.  The  hypotonia  and 
sensory  symptoms  remain  practically  unaffected,  although  very 
frequently  they  seem  to  improve,  probably  because  the  patient's 
mind  is  diverted  from  them  and  directed  to  the  acquirement  of 
muscular  skill;  the  improvement  in  muscular  control,  however, 
may  remain  for  years. 

The  ideal  result  would  be  the  restoration  of  the  normal  accuracy, 
control,  and  velocity  of  the  movements,  a  result  which  Frenkel 
claims  to  have  achieved  in  many  cases.    The  restoration  in  locomo- 
tion is,  however,  generally  sufficient  to  enable  the  patient  to  resume 
his  usual  business  or  profession,  and  this  is  all  that  may  be  expected. 

In  one  case  coming  under  my  own  observation,  treated  by 
John  K.  Mitchell  at  the  Orthopadic  Hospital  in  Philadelphia, 
and  not  by  any  means  an  unusual  one,  a  miner  from  California 
who  came  bedridden  and  accompanied  by  an  attendant  improved 
to  such  an  ex.<.nt  that  he  was  enabled  to  travel  across  the  continent 
by  himself  and  resume  the  active  management  of  his  mines. 
Such  a  result  is  so  frequent  as  to  be  almost  the  rule. 

The  improvement  is  more  or  less  lasting  as  the  patient's  occupa- 
tion does  or  docs  not  entail  constant  overstrain.  If  the  ataxia  does 
increase  again,  a  course  of  exercise  will  once  more  bring  it  under 
control. 

In  giving  a  forecast  of  the  progress  to  be  expected  in 
any  case  the  natural  disposition,  the  alertness,  and  the  ability 
for  muscular  exercise  n  ist  be  found  out  and  given  full  weight  by 
the  surgeon.  The  more  skilful  patients  will  make  more  rapid 
progress,  and  the  best  results  are  obtained  among  those  who  have 


THE   TKEATUENT   OF    LOCOMOTOR    ATAXIA   BY    EXERCISE     393 

been  accustomed  to  work  demanding  dexterity,  or  who  have  been 
successful  devotees  of  athletic  sports,  men  who  have  lived  a  good 
deal  in  their  muscles,  and  who  have  at  one  time  had  the  muscular 
sense  well  developed. 

Another  important  factor  is  the  patient's  personal  courage. 
Apprehensive  or  cowardly  patients  will  not  risk  the  slightest  move- 
ment without  support  or  attention,  and  will  have  to  practise  for 
a  long  time  before  much  definite  improvement  can  be  noticed. 
The  longer  and  more  thoroughly  a  course  is  continued,  the  more 
certain  and  lasting  will  be  the  improvement,  and  the  closer  will  the 
patient  approach  to  the  normal  in  motor  capacity  and  accuracy 
of  movements. 


INDEX 


Abdohinal  ctHitrol,  cxcrcUea  (or,  339 

Acridents  in  athletics,  tgo 
Activity  of  child,  158 
Adami  on  dilatation  of  heart,  J17 
Adam's  position,  383 
Age  limit  in  games,  135 
Amherst,  Dr.  E.  Hitchiotk  at.  i/j 
German  gjm.iastics  at,  83 
physical  education  at,  175 
Anatomy  in  jiu  jitsu,  109-113 

of  hernia,  363 
Anders  on  obesity,  346 
Anemia,  exercise  in,  336 
Apparatus  employing  friction,  64 

Goldthwait's,  for  round  shoulders,  363 
gj-mnastic,  origin  of,  138 

physioUigical  classification,  139 
Lovett's,  for  stretching  round  shoul- 
ders, 264,  365 
school  furniture  as,  166 
Swedish,  loi 
Argyll-Robertson  pupil  in  ataxia,  383 
Arnold,  E.  H.,  on  games,  164 
Arterial  tension,  measurement  of,  34 
Arteriosclerosis,  causes  of,  323 
definition  of,  323 
diagnosis  of,  324 
in  Cornwall  miners,  333 
Peacock  on,  332 
Articulation,  teaching  of,  305 
Artificial  respiration,  33a 

Sylvester  on,  361 
Astigmatism  in  scoliosis.  Rogers  on,  276 
Ataxia,  Arg>-H -Robertson's  pupil  in,  383 
exercises  for,  385 

treatment  of,  384 
Frenkel  on,  384 
John  K.  Mitchell  on,  392 


Ataxia,  prognosis  of,  393 
rapid  fatigue  in,  3gi 
Romberg's  symptom  of,  383 
Stewart  on,  383 
symptoms  of,  383 
Athletes,  examination  of,  190 
scholarships  of,  190 
Stengel  on  heart-murmurs  in,  319 
Athletic  League  in  N.  V,  Public  School, 
16S 
in  public  school,  efficiency  tests  in, 
170 
sports,  conduct  of,  190 
training,  aims  of,  42 
dangers  of,  42 
;  Athletics,  accidents  in,  190 
class,  184 
for  blind,  19^ 
'      specialization  in,  i8g 
j  Automatism  in  exercise,  41 

Back,  examination  of,  354 

Balck.  Colonel  Victor  Oustave,  91,  102 

Balfour  on  neuralgia,  373 

Barr,  Maurice  E.,  on  mental  defectives, 

314 
Bartlett  gymnasium,  Chicago,  175 
Basedow,  74 
Bed-posture,  Brackett  on,  380 

Fitz  on,  380 
Beevor  on  tests  for  paralysis,  ^74 
Bell,  Sir  Charles,  30 
Benke  on  heart  growth,  ^8 
Bernadotte,  sympathy  with  IJng,  88 
Bernard,  Claude,  lectures  of,  90 
Beveridge's  rubbers,  96 
Bezly  Thome  on   exercise    for    heart, 
325-339 

395 


396 


Birycling,  effect  on  blood,  ,^3 
Hithup,  Emily,  on  I>rlMnr,  115-117 
Blake  on  nmnithon  races.  J20 
Blind,  athlciiiB  for,  joi 

compuliory  exeiriie  fur,  197 

exeniir  f<ir,  195 

games  (or,  i^M 

Eymnatium  (unrlruction  for,  195 

meaturementt  of,  195 

phyiiial  eduratitin  for,  195 
limitations  of,  194 

recreation  for,  197 

Van  de  Walker  on,  199 
Blood-count,  J.  K.  Mitchell  on,  337 

of  athletes,  31 
Blood-pressure,  Bowen  on,  317 

Brunton  on,  35 

during  effort,  so 

effort  on,  .^5 

exercises  of  enduorce  on,  37 

Jancway  on,  35 

McCurdy  on,  36 

Stephens  on,  35 

variations  of,  35 
Bolin,  Jakob,  on  constipation,  363 
on  exnmination  for  scoliosis,  383 
on  paralysis,  376 
Bowen  on  blood-pressure,  317 

on    pulse-rate    and    temperature    in 
ejwrcise,  37 
Brackett  on  bed-fXMture,  380 
Branting,  88-90 
Breathlessneas,  facial  expression  of,  33 

head  poise  in,  34 
Brehmer's  rule,  337 
Brookline,  municipal  baths  of,  153 

gymnasium  of,  153,  156 
Brown    University,  German  gymnastics 

at,  82 
Brunton  on  blood -pressure,  35 

on  high  tension  in  arteries,  323 

on  muscular  contraction,  31 
Burgdorf,  Spiess  at,  80 
Butler  on  deep  breathing,  334 

Call,  Anna  Payson,  on  Delsarte,  115- 

117,  118 


Caie-rcportt  on  irolkMit,  305 

C  -ntral  Institute,  founding  of,  S7,  90 

C  hau(aui|ua,  summer  ■ch<iol  at,  191 

Chest  expansion,  exercises  for,  338 

Chcync,  caac-rejiort  of,  355 

ChUtio,  Captain,  on  |N)]ymachini>n,  56, 

S7 
Chicago  University,  physical  education 

at,  176 
Child,  normal  activity  of,  158 
Chorea,  380 

treatment  of,  381 
Circulation,  influence  of  games  on,  136, 

137 
City  homes,  condition  of,  140 
CUrk,  E.  E.,  on  falietlu  voice,  380 
Class  work,  exhilaration  from,  130 

progression  in,  189 
Clifford- Al butt  on  heart-strain,  3  to 
College  gymnasium,  et|uipment  of,  185 

life,  physical  effects  of,  181 

of  City  of  New  York,  physical  educa- 
tion at,  176 

yearl\  course  in  exercise,  t86 
Columbia  University,  summer  9rho(d  at, 

191 
Concentration  of  attention,  31 
Conditioning,  effects  on  fatigue,  33 
Constipation,  Bolin  on,  363 

exercise  for,  361 

frecjuency  of,  360 

massage  in,  336 

Zander  on,  363 
Copenhi^n,  75 

Cornwall  miners,  arteriosclerosis  in,  333 
Correspondence  schools  of  exercise,  119 
advantages  of,  i30 
dangers  of,  131 
Crime,  juvenile,  138 
Criminals,  characteristics  of,  217-330 

Wey  on,  330 
Curtain  hall,  Sargent's,  128 
Curves  of  normal  spine,  350 

Daily  exercise,  Gulick  on,  134 

set  of  free  exercises,  134 
Darmstadt  normal  school,  80 


INDEX 


m 


Dwwta,  *Q 

Day'i  order,  I  (n^'t,  93 

origin  of,  9 1 
Dcaf-muiM,  iMiUnce  movemenU  (or,  toy 

exeniM  (or,  aott 

gamet  for,  30Q 

longevity  of,  20ft 

mcuurementi  of,  ios-mq 

phyilral  [in-ulkritin  of,  305 
Deep  l»reathing,  Butler  on,  334 

exrniiei  for,  aaS 
Defitrmed  icapuia,  (^otdlhwail  on,  a66 
Deformities  of  foot,  356 
Delin(|uents,  military  drill  for,  317 

phyiiral  education  tut,  317 
Deliarte,  Anna  Pavson  Call  on,  1 1 5,  1 1 7, 
118 

Bishop  on,  115-117 

Geraldy  on,  115 

Giraudet  nn,  115 

life  of,  114,  115 

Stchbins  on,  115-117 

aayings  of,  1 15 

Steele  Mack.iv-e  on,  115 

system  of,  115 
Deaaau,  74 
Developing  apparatus,  Goldie's,  63 

Sargent's,  60,  61 
Diabetes,  exercise  for,  357 

Finkler  on,  357 
Diagnosis  of  arteriosderiosis,  334 

of  flat-foot,  342 
Dilatation  of  heart,  317 

Roy  and  Adami  on,  317 
Du  Bois- Raymond,  81 
Dullards,  improvement  of,  231 

physical  training  for,  220 
Dumb-bell,  Sandow's  spring,  118,  iig 
Dumb-bells  used  by  Greeks,  57 
Dyspepsia,  exercise  in,  360 
nervous  Weir  I  Mitchell  on,  360 

Ebebhart  on  vibrators,  71 
Eccleson  massage  in  sciatica,  371 

on  neuralgia,  372 
Edinger's  theory  of    locomotor  ataxia, 

382 


Education  of  immifimnit  by  |>Uysroundik 

140 
EIRcuragc,  tirsi  n|>ti<m  of,  50 
Effort.  liliMMl-prewurr  during,  ao 
economy  In,  ,^ 
effect  on  muhles,  31,  33 
exercises  of,  18 
muscle  rupture  fn>m,  30 
on  blixid-pressure,  35 
i|ualitles  rullivateil  by.  at 
Elmira  State  Penitirntiary,  330 
Emerson.  C.  W.,  exercises  trf,  ti8 
Endurance,  excrtlirs  of,  18 
Enehuske,  Ctaes,  03 
Equipment  of  college  gymnasium,  185 
of  lai^  playground,  150 
of  school  gymnasiums,  if>7 
of  small  playground,  143 
Erector  spinir,  actio"  of,  297 
Evolution  in  play.  124 
Examination  for  acotiosis,  38} 
Bolin  on,  282 
of  athletes,  iqo 
of  hack,  254 
of  itat-f<x>t,  241 
of  t)ljesitj-.  34ft 
pliysical,  of  students,  176 
Exercisff,  active.  17 
automatism  in.  41 
class  credit  for.  i8i 
corresjtondc ivt-  schools  of,  1 19 
daily,  Gulick  on.  134 
detinition  of,  17 
for  ataxia,  385.  389 
for  Wind,  195,  197 
for  constipation,  361 
for  deaf-mutes,  206 
for  diabetes,  357 
for  gout.  356 

for  heart,  Bezly  Thome  on,  325-329 
Heineman  on,  325-345 
weakness,  325 
for  hernia,  366 
for  ttcoliosis,  2Q4 
for  sedentary  o^cu|)ations,  134 
for  tuberculosis,  227 
free,  daily  set  of.  134 


398  ,N 

EwrclM  In  •nemU.  aa6 
in  cuUeir,  Benjsmln  Franklia  on,  174 

Jefleraim  ftn,  174 
in  ilyaiiriMia,  \tto 
in  Kaurilli,  359 
In  morning,  154 
in  old  ttgr,  130 

in  luitKilngitiil  cimdiiiont,  333 
In^truitiiin  In  theory  nf,  iiji 
tit  endurume  for  goul,  236 

pBMi\T,   17,   J  7 

elTct  tt  »f,  3i 
in  fatigue,  27 
on  Atrophy,  ji 
periods  in  xhoitl,  164 
prrxription  for  m»lio»Iii,  joo 
lonlf  effen  nf,  jj6 
yearly  course,  in  (ollege,  1H6 
Exercises  for  abdiiminal  ronirol,  jjq 
for  chett  ex|>ansion,  33S 
for  flai-fout,  3i}3 
for  heart,  Satterthwaite  on,  ^^^ 
fur  nervous  <liKa8es,  Ji6 
for  nliesity,  35^ 
fnr  niund  shouldem.  357 
gymnasiir,  physiological  rlas«itiratiun 

I  JO 
*rf  deep  breathing,  13H 
of  effcrt,  18 
»rf  endurance,  18 
de9iri))tiori  of,  23 
effects  of,  :^l 
rxcess  in,  32 
fatigue  pnxlucts  in,  33 
on  l)l(M>d-pre»iure,  37 
on  heart,  ,i8 

(|ualilies  rullivaled  by,  23 
of  skill,  18 
schtK)!,  81 
Exhaustion,  16 

from  alertness,  40 
Exiiei  lalion  of  life.  Farr's  tables  on,  321 
Ej-e  examinations  of  students,  i7g 

Facial  expression  as  ind^x,  21 
of  breathlessness,  23 
of  effort,  19 


Fkcttl  expreiiion  of  fatigue*  24 
of  rage,  30 
tit  strain,  ao 
Fahrner  rtn  fatigue  at  h  huol,  379 
Farr't  la)>les  of  ex|iet  tation  of  life,  jai 
Fatal  iDUc!:,  JafMneie  107 
Fatigue,  acute,  33,  a 
chnmic,  36 

ladal  expresaion  of,  94 
fever,  44 
general,  34 

efTe«  Is  of,  3j 
in  ataxia,  .)qi 
maiKige  in,  49,  333 
pasiive  exenises  fnr,  37 
poise  of  head  in,  35 
products,  intoxication  by,  41 

Lee  on.  43 
relative,  .w 
scoliosis  of,  378 
stiUicute,  36 
temjierature  in,  jfi 
Faulty  attitude,  varieties  of,  353 
Feeble  miniledness,  physical  iignt  of,  310 
Fellcnberg,  74 
Femald,  311-313 
Kinkier  on  dialietes,  357 
Finsen,  75,  76 

Fitz,  Cettrgr  W.,  on  mund  shoulders,  155 
on  Ited-jMJsturc  in  scoliosis,  380 
on  round  shoulilers,  363 
tiiethod  of  measurement  in  scoliosis. 
3S3 
Flat-f«>ot,  cause  of,  238 
diagnosis  :)f,  343 
examination  of,  341 
exercises  for,  342 
freijuency  of,  240 
Ochsncr's  Imndage  for,  348 
record  of,  241 
Rol     on,  246 
shf--  for,  246 
syiii|.toma  of,  339,  240 
tn-iiiment  cif,  243 
Whitman's  foot-plate  for.  347 
Folk-dancng  in  playgrounds,  152 
Follen  at  Harvard,  82,  175 


INOIX 


Food  and  mutruUr  wtUt,  41 
Foo«,  deformiiict  of,  jj6 
laiml  «rch  o|,  sjg 
HrtKlure  at,  336 
Fom-UII  playtra,  weight  irf,  iflo 
Frankfurt,  lurnfrtt  at,  ;q 
Franklin,  Benjamin,  cm  exrrriie  In  tol- 
•*lie.  174 
Field,  184 
Frrnkel  un  auxia,  384 
Fridion,  dett  ription  ul,  51 
Fn«)«l,  80,  134 

CjAlen  on  maHage,  ^o 
GamrH,  u^r  limit  in,  uj 
(lauirKntlun  <tf,  w6,  u; 
iiillrtiiuna  of,  ifij 
ft>r  hliml,  i(>« 
for  tleaf-tnulffl,  209 
g.vmna8li<,  ij8 
in  rrtrsB,  16^ 

ir.fluemcon  drrulation,  116,  127 
musilca  used  in,  13ft,  1^7 
nerwionirol  rei(uimJ  in,  uA,  ij; 
p«»|»ularityof <hilrln-n's,  laa 
theru[«utic  effects  of,  uS 
Gang  instinti  in  \ki\%  li^ 
Garlwr'aniljustable  desk,  160 
Garland,  15] 
Gaslriiis,  exfrriae  in,  359 

massage  in,  336 
Genrgii,  88-90 
Geraldj-  on  Dcliarte,  115 
German  gymnaatits,  first  manual  of,  75 
in  America,  83 
system,  history  of,  74 
jieculiarities  of,  84 
Slecher's  riassifiiatidn,  85 
Oiessen,  Spiess'  work  at,  80 
Giraudet  on  f)clsarte,  115 
Glen  Mills,  school  at.  arS,  jiq 
Goldie's  exerciser,  61 
Goldthwait  on  deformed  scapula,  366 

on  round  shoulflers,  ssj.  356 
Goldthwait '9  apparatus  for  round  shoul- 
ders, 363 
Could  on  causation  ot  scoliosis,  375-377 


399 


Gould  on  wriiinf  podilon,  391 
(iiHii,  rwniae  Utr.  356 

irealmeni  >4,  jjt, 
<iraham.  IhiuKlai,  on  rheumatism,  358 

(HI  •rialita,  171 
Granville  J.  Moriimrrs  ihei«-y  tA  pain, 

.173 
(iranville'a  i»errutor,  373 
Green,  (irare,  308 
fHi  deaf  girU,  305 
Greenwood  on  normal  [Mxiure,  ajj 
Gulick  on  athleik  league,  168 
on  daily  exercise,  134 
I'H  games,  133,  133 
iwv  |ilay  traditions,  164 
(luts-Muths,  74,  75,  Ho 
Gymnasium  <..n*tniition  for  blind,  195 

tintt  public,  83 
Gymnasium-'chixil,  e((ujpmenl  of,  167 
Gymnastic  apparalui,  vlassificalion  of, 
139 
for  mental  flefectives,  jij 
formal,  in  child-training,  134 
ill  ptaygr.iunda,  150 
instifutt  in  Berlin,  Kt 
lesson,  arr;   :Tmeni  of,  130 
medical,  I.  , innings  of,  88 
*h.  ,>1,  tieginnings  of,  88 
Swedish  medicaJ,  103 

Hartemis,  90 
HartWTlI,  93 
Harvard,  Follen  at,  17s 
Hawk  on  blocxi-iount,  31 
Heart,  Bczly  Thornc  oncxerciae  for,  335- 
3 '9 
dilatation  of,  317 
diseases  of,  315 

action  of  exerc  ise  in,  33^ 

Wide  on  massage  for,  335 

exercises  of  enduram  e  on,  38 

Saltcrthwaite  on,  341 
growth,  Benke  on,  38 
Heineman  on  exercise  for,  335-345 
murmurs  in  athletes,  Stengel  on,  319 
of  oarsmen,  330 
overstrain  of.  317 


400 


Heart,   prognosis  of  exercise  treatment 
for,  345 

strain,  Clifford- Albutt  on,  319 
Schott  on,  317 

valvular  defects  of,  315 

weakness,  exercise  for,  225 
Heat,  regulation  of,  ig,  30 
Heineman  on  heart  exercise,  325-345 
Hemenway  Gymnasium,  175 

Mrs.  Mary,  92 
Henry,  Admiral,  case-report  of,  359 
Hermann,  rout  of,  76 
Hernia,  362 

anatomj'  of,  363 

diagnosis  of,  363 

ejcercise  for,  366 

Seaver's  truss  for,  365 

supiKirt  for,  365 
High  tension,  Brunton  on,  323 
Hippocrates  on  conditioning,  44 
Hitchcock  at  Amherst,  175 

on  measurements,  191 
Hokusai,  sketches  of,  105 
Homans,  Miss  Amy  M.,  93 
Hooker  at  Amherst,  175 
Horizontal  bar  controversy,  81 

Ideal  college  athlete,  193 
Indianapolis,  college  at,  82 
Inomotor,  Sargent's,  64 
Intoxication  of  fatigue-products,  41 

Jahn,  74-77,  80 

Janeway  on  blood-pressure,  35 

Jefferson  on  exercise  in  college,  174 

Jiu  jitsu,  dangers  of,  113 

introduction  in  America,  108 
knowledge  of  anatomy  in,  109-112 
modifications  of,  108 
O'Brien  on,  108,  111,  113 
origin  of,  104 
secrets  of,  106 

Jiudo,  104 

Juggling,  physiology  of,  21 

Kano  school  in  Tokyo,  108 
Keynote  position.  Roth's,  382,  295 


Kidneys,  action  of,  in  elimination«44 
Kindergarten,  games  of,  i6t 
Kinghorn  on  phthisis,  227 
Kitson,  H.  H.,  193 

Kuatsu,  art  of,  104,  106,  107 

Lagrange,  328 

Larabee  on  Marathon  runners,  320 

Latent  period,  30 

Lee,  F.  S.,  on  fatigue-products,  43 

J-  E.,  .37 
Lefebure  on  day's  order,  101 
Lever,  principle  of,  6g 
Lieber,  77-82 
Liedbeck,  88 
Ling,  Hjalmar  Frederick,  90 

honors  awarded  to,  88 

literary  activity  of,  87,  88 

on  massage,  46 

Peter  Henry,  74,  81,86 
life  of,  86 

physiology  of,  89 
Lip  reading,  teaching  of,  206 
Locomotor  ataxia,  definition  of,  382 

Edinger's  theory  of,  382 
Lombard  on  weight  loss,  42,  43 
Longevity  of  oarsmen,  Meylan  on,  321 
Lovett's  apparatus  in  round  shoulders, 
261,  265 

measurement  of  round  shoulders,  251 
Lund,  University  of,  86,  87 
Lung  capacity,  rapid  increase  of,  313 

Macdonald  Smith  on  full  contraction, 

117,  118 
Machine,     McKenzie's,     for     scoliosis 

measurement,  384,  285 
Maggiora,  experiment  of,  on  massage, 

47-49 
Makuen  on  artistic  breathing,  378 
Marathon  race,  44 

Blake  and  Laraliee  on,  320 
Mason,  J.  L..  154-156 
Massage,  action  on  muscles,  47 

as  stimulant,  333 

automatic,  39 

classification  of,  5' 


401 


Massage,  detinitinn  of,  45 

derivalion  iif,  45 

duration  of,  55 

effects  of,  ^A 

for  fatigue,  4q 

f(ir  heart  disease,  Wide,  325 

for  muscle  wasting,  31 

for  obesity,  335 

for  rheumatism,  358 

general,  54 

hisliiry  (if,  45 

fur  ronsiipation,  226 

for  fatigue,  222 

(or  gastritis,  226 

in  Oreeie,  45 

in  Japan,  45 

on  nervous  system,  41 

for  neuritis,  371 

for  ol)esity,  352 

for  rheumatism,  22A,  358 

for  sciatica,  371 

for  sprains,  223 

Ling  on,  46 

Maggiora's  experiments  on,  47-49 

mechanical  effects  of,  49 

Mezgar  on,  46 

precautions  in,  55 

rc([uirements  of,  46 
McCurdy  on  l)l(K>d -pressure,  36 
McKenzie's  machine  for  measurement 

of  scoliosis,  2S4,  285 
Mvtisurement,  Filz's  methixl,  in  scoliosis, 

McKenzie's  method  in  scoliosis,  2S4, 

285 
of  blind,  195 
of  deaf-mutes,  305-209 
Roth's  method,  in  sc<)li(«is,  283 
Schulthess'  machine  for,  283,  284 
Spellissy's  method,  in  scoliosis,  283 
Mechanotherapy  in  America,  71 
Medical  gymnastics,  sujwrvision  in,  235 

Swedish,  103 
Melville  Bell  on  stammering,  378 
Mental  defectives,  Barr  on,  214 
diagn(«is  for,  212 
gymnastics  for,  21a 


Mental  defecti\-es,  habits  of,  ju 
management  of,  31 1 
military  drill  for,  214 
]iniiKirtions  ^>i,  210 
sch(M)ls  for,  212 
Tadd  on,  216 
Warner  on,  21 1 
Meylan,  Geo.  L.,  157 

on  longevity  of  oarsmen,  321 
Me/gur  on  massage,  46 
Military  drill  for  dclinijuents,  217 
for  mental  dcfeciivcs,  214 
gymnastii  s,  Swedish,  94 
Mind  and  Ixxly,  H3 
Mitchell  on  ataxia,  392 
on  bloiKl  changes  fn»ni  massage,  32 
on  blood-count,  227 
Montrichard,  86 

Morgan  on  survival  of  oarsmen,  321 
Mosher  on  standing  ]R)Sture,  165 
Mosso's  plethysmograph,  31,  32 
Mount  Airy,  208 

institution  for  deaf-mutes,  206 
Movements,  automatic,  39 
l»rain,  control  of,  39 
necessity  for  natural,  40 
s|)ontaneouB.  in  infants,  122 
Muller  on  tifteen  minutes  daily  exercise, 

Murray,  qi 

Muscles,  action  of  massage  on,  47 
of  spine,  271 
overdevelopment  of.  22 
ruptured,  cause  of,  30 

from  effort,  30 
soreness,  cause  of,  29 
tonus,  29 

used  in  games,  126,  127 
Muscle-wasting,  massage  for,  31 
Muscular  action,  isolation  in  treatment 
of  scoliosis,  296 
contraction,  lirunton  on,  31 
des<ri]ition  of,  29 
effects  of,  29 

NArHTFGAI.L.   74,   75,  86,  87 

Nephritis  from  fatigue,  44 


402 


Nervous  diseases,  exerdses  for»  226 

dyspepsia,  Weir  MitchelJ  on,  360 
Neuralgia,  Balfour  on,  372 

Ecdes  on,  373 
Neurasthenia,  ireatment  of,  376 

Weir  Mitchell  on.  376 
Neuritis,  massage  in,  371 
Neuroses  of  occui»tion,  372 

treatment  of,  373 
New  York  City,  overcrowding  in,  137 
Newark  Athletic  League,  1 73 
Newton  01  blood-pressure,  35 
Nibecker,  221 
Nissen,  92 
Nyblaeus,  Col.  Gustave,  go 

Oarsmen,  hearts  of,  320 

Meylan  on  longevity  of,  321 

Morgan  on  survival  of.  321 

mortality  of,  321 

weight  of,  180 
Obesity,  causes  of,  346 

complications  of,  349 

degrees  of,  398 

diet  in,  3^1 

examination  of,  348 

exercises  for,  352 
Anders  on,  346 

local,  346 

massage  in,  225 

prognosis  in,  348,  355 

rapid  reduction  of,  352 

reduction  cures  for,  350 

thyroid  extract  in,  354 

treatment  of,  225 

Von  Noorden  on  massage  for,  35  a 
O'Brien,  J.  J.,  on  jiu  jitsu,  108,  1 1 1,  113 
Occupation  disorders,  2215 

evil  effects  of,  133 

neuroses  ot,  373 
Ochsner's  bandage  for  flat-foot,  248 
Oertel's  cure,  325,  326 
at  Reichenhail,  328 
limitations  of,  328 
experiments,  327 
Old  age,  exercise  in,  130 
Orton,  George,  157 


Overcrowding  in  New  York  City,  137 

Overtraining,  effects  of,  36 


Pain  organ,  73 
Pantc^aph,  tracings  by,  253 
Parallel  bars  controversy,  Si 
Paralysis,  Beevor's  tests  for,  374 
Botin  on,  376 
infantile,  373 

regions  involved,  374 
prognosis  of,  376 
treatment  of,  376 
Pathological  conditions,  exercise  in,  232 
Peacock  on  arteriosclerosis.  322 
Pelvic  girdle,  structure  of,  250 
Pentathlon,  74 
Percussion,  52 
Percutor,  Granville's,  372 
Pestalozzi,  79,  80 
Petrissage,  description  of,  53 
Philadelphia    Playgrounds  Association, 

173 
Philanthropinum,  74 
Phillips  on  sprinters,  192 
Phthisis,  Kinghorn  on,  227 
Physical  education  at  Amherst,  175 
at  Chicago  University,  176 
at  College  of  New  York,  176 
at  Harvard.  175 

at  University  of  Pennsylvania,  176 
for  Hind,  195 

fundamental  principles  of,  182 
research  in,  191 
ideal,  193 

intelligence,  value  of,  182 
limitations  of  blind,  194 
peculiarities  of  deaf-mutes,  205 
training  for  delinquents,  217 
for  dulness,  220 
Physiological  load,  law  of.  57 
Piano  playing,  21 
Pilgrim  on  vibration,  71-7^ 
Platj-sma,  action  of,  19,  20 
Play,  evolution  in,  124 
Playground  Association,  American,  82 
German,  83 


Playground    Committee,    New     York, 
work  of,  137 
effect  on  emigrants,  140 
equipment  of,  large,  150 
private  house,  143 
sma]l,  143 
folk-dancing  in,  153 
gymnastics  in,  150 
how  founded,  140 

plan  of,  148 
Philadelphia,  173 
public  sihcK)!,  144,  147,  [53 
roof,  167 

round  games  in,  153 
sufX-Tvision  of,  150 
swimming  in,  152 
lyj)e9  of,  141 
Plethysmograph,  Mosso's,  ^r,  33 
Polymachinon,  Chiosso's,  56,  57 
Posse,  Q1-Q3 

gymnasium,  93 
Posture,  correct  sitting,  161 
standing,  165 
defects  of,  225 
exercise  for,  224 
faulty,  varieties  of,  252 
in  sch(x>l,  160 
normal,  Greenwood  on,  253 
standing,  change  of  spine  in,  250 
Mosher  on,  165 
Roberts  on,  259 
spinal  curve  in,  250 
Presence  of  mind,  40 
Prognosis  in  ataxia,  392 
in    exercise     treatment     for      heart, 

345 
in  obesity,  348,  355 
in  paralysis,  376 
in  round  shoulders,  356 
Prolongation  of  life,  Weber  on,  131 
Psoas,  isolation  of,  3t}6 
Public    School    Athletic    League,    girl's 
branch,  172 
grounds  of,  172 
Pulley-weights,  dangers  of,  63 
description  of,  5S-6a 
limitations  of,  63 


j  Pulley-weights,  principle  of,  57,  58 
Pulse-rate  in  exercise,  Bowen  on,  37 
Zander  on  reducing,  325 

Quarter  CIRCLE,  59,  60 

Race,  facial  expression  of,  30 
Record  of  fiat-fcxjt,  341 
Reichcnhall,  Oertell's  cure  at,  328 
Research  in  physical  ccimaiion,  iqi 
Respiration,  artificial,  233 
Japanese,  107 
chemistry  of,  33 
Rheumatism,  Douglas  Graham  on,  358 
massage  in,  226,  358 
vil)ration  for,  358 
Rifle  sh(x)ting  in  schools,  170 
Riva-Rocci  sphygmomanometer,  ^5 
Roljerts  on  standing  iK)8ture,  259 
Rogers  on  astigmatism  in  scoliosis,  276 
Romberg's  symptom  of  ataxia,  383 
Roth,  Bernard,  90 
on  flat-foot,  240 

on     method     of     measurement     in 
scoliosis,  383 
Matthias,  90 
Roth's  keynote  [K>sition,  383-295 
Rothstein,  81,  89 
'  Round  'ii-k,  tracings  of,  353 
shoulders,  causes  of,  254 
definition  of,  251 
diagnosis  of,  256 
exercises  for,  257 
Fitz  on,  255,  26-* 
frequent  y  of,  255 
Goldthwait  on,  255,  256 
Gt>ldthwait's  apparatus  for,  263 
Lovett's  apparatus  for.  364,  365 

measurement  of,  251 
prognosis  of,  256 
treatment  of,  256 
Zander's  lower  for,  262 
Rousseau,  74 
Roy  and  Adami  on  dilatation  of  heart. 

Running,  change  of  pace  in,  27 
long-distance,  36 


n 

! 

404                                                         INDEX 

Il*  ^ 

Salzm/   ,  74 

Scoliosis,  examination  for,  282 

Samauri,  order  of,  104,  105 

exercise  for,  294 

^■'' 

Sandnw's  s|iring  (lumlHlieU,  118,  iiq 

c\[>erimcntal,  381 

Sandpi'e,  care  of,  144 

Filz's  method  of  measurement,  283 

Sargent,  Dudley  A.,  at  Har%'ard,  175 

frci|uency  of,  274 

on  curtain  ball,  128 

(iould  on  causation  of,  275-277 

^^^^^H  , 

on  devflopiig  apparatus,  60,  61 

isoUtion  of  muscular  action  in  ireat- 

^^^^^B  . 

on  inomotor,  f)4 

nient  of,  296 

on  measurements,  iqi,  ig,^ 

measurement  of,  283 

^ 

^^^^^^1  ' 

on  pulley  weights,  5?-<>i 

of  fatigue,  278 

S  tterthwaile's  exercises  fur  heart,  ,^4.1 

prescription  .>f  exercise  for,  300 

SavTe's  aling,  304 

[)rognosis  of,  290 

SrhnepfcPthal,  school  of,  74 

Roth's  method  for  measurement  of. 

^^H' 

Sch<K4ljc)ys,  examination  of,  r;^ 

^83 

Sch<x>l,    rules  for  construition  of   desk, 

R<iger'8  on  astigmatism  in,  376 

^^^^^^^B 

293 

Schulthess'  machine  for  mcasurenifril. 

^^^^^^^B 

for  mental  defectives,  2 1 3 

283,  284 

^^^^^H£ 

furniture,  adjustable,  159 

Spellissv's    method    of    measurement. 

as  apparatus,  166 

'»} 

rules  for,  [59 
gymnasium,  equipment  of,  167 

symptoms  of,  289 
treatment  of,  391 

^^^^^V  ' 

house,  construition  of,  15S 

varieties  of,  2S8 

^^■1 1 ' 

life  and  scoliosis,  279 

Scudder  on  school  seatinR,  15S 

^^^^^^H ' 

posture  in,  160 

Seaver  on  mcasurcmenis.  191 

^^^^H 

recess,  163 

Seaver's  truss  for  hernia,  36^ 

^^■'i 

room,  graded  work  in,  165 

Second  wind,  24 

lighting  of,  294 

Sedentary  iHcu|)aiions,  exercise  for,  134 

■:';' 

fatigue,  Fahrner  on,  279 

Self-massage  on  nutrition,  31 

seating.  Scudder  on,  158 

Sex,  in  play,  124 

Schott  on  heart-strain,  317 

Shaking,  description  of,  53 

^^^^^■l 

treatment  at  Bad  Nauheim,  328 

Shaw  on  school  day.  161 

^^B'^ji 

description  of,  328 

Shoulder-girdle,  structure  of,  250 

Hi  ^ 

Schulthess'  machine  for  measurement  of 

Shoulders,  forward  displacement  of,  253 

scoliosis,  383,  284 

uneven,  2b6 

Schwanenrede,  Jahn's,  77 

causes  of,  267 

^^^^■'* 

Schwann's  law  of  mus*ular  contraction. 

prognosis  of,  270 

^^^H ' 

69 

treatment  of,  267 

^^^B 

Sciatica,  Ecdes  on  massage  for,  371 

Sillow,  91 

^^^■,. 

Graham  on,  371 

Singing  with  gymnastics,  81 

vibration  for,  371 

SkiU,  exercises  of,  18 

Scoliosis  and  school-life,  279 

progression  in,  40 

^H 

bed-iK)sture  ii.,  280 

Small  shoe  for  flat-foot,  346 

^^^^H 

Bolin  (m  examination,  282 

Social  center,  Chicago,  150 

^^^H 

case-reports,  305 

Speech,  mechanism  of,  378 

causes  of,  275 

Si>eed -skaters,  measurements  of,  193 

^^^1 

development  of  thorax  in,  312 

Spellissv's     photographic     meih.wi     for 

diagnosis  of,  286 

measurement  in  scoliosis,  383 

■i 

Sphygmomanometer,  Stanton's,  34 

Spiess,  74-80 

S]»inal  asfisiant,  Ta>lur's,  itn,  264 

curve  change  in  siandinK  I»<»slure,  250 
Spine,  infantile,  shajie  of,  350 

movements  of,  272 

muscles  of,  271 

normal,  (urves  of,  250 
Sporting  Times,  founding  of,  01 
SiKtrts,  analysis  for  class  use,  1S5 
Sprains,  massage  in,  222 
Sprinters,  Phillips  on.  i(j2 
Stagg  on  weight  reduction,  352 
Stairway,  Von  Leyden's,  385,  386 
Stalencss,  22,  41 
Stammering,  377 

Bell  on,  37S 

frequency  of,  37S 

treatment  of,  379 
Stan<ling  attitude,  normal,  351,  252 
Stanton's  5i»hygmomanoniuter,  34 
Starr  Garden  Playground,  plan  of,  147 
Stel)l)ens  on  Delsarte,  115-117 
Stecher,  Wm.  A.,  83 
Steele  Mackaye  on  Delsarte,  115 
Stengel,  heart-murmurs   in  alhletes,  319 
Stephens  on  l)ltK>d-i)ressure,  35 
Stewart  on  ataxia,  383 
Stokes,  325,  326 
Strain,  facial  expression  of,  20 
Striking,  52 

Stroking,  descripti<'n  of,  50 
Students,  eye  examinations  of,  179 

physical  defects  in,  177 
excess  of,  176 
Subtarget  machine,  170 
Summer  camps  for  ritv  children.  157 
V.  M.  C.  A.,  157' 

schools.  191 

at  Chatauqua.  :.vi 
at  follegL-  of  City  of  New  York,  itji 
Supervision  in  medical  gymnastics,  235 
Syl/ester  on  artificial  respiration,  261 
Symptoms  of  flat-fi>ot,  239,  240 
Swedish  apparatus.  101 

gymnastics     introduced     in      United 
States,  91 


JtX  405 

I  Sweedish     gymnastics,     limitations    of, 

lOI 

military,  94 
'      medical  gymnastics,  103 
system,  characteristitsof,  94 
Swimming  In  playgrountls,  152 

Tadd  on  drawing  for  defectives.  216 
Ta|>otement,  description  <»f,  52 
Taylor  <»n  developing  ap[Hiratus,  70 
Taylor's  "  spinal  assistant,"  262,  264 
Techow,  89 
Temi»erature  during  exercise,  Bowen  on, 

rise  <)f,  in  mustular  action,  29 
Tendon,  strain  i>f.  30 
Therajwutic  effects  of  games,  1 28 
Thorax,  torsion  of,  299 
Thyroid  extract  in  olicsity.  354 
"  Tidschrift  i  Gymnastics,"  90 
Torngren,  91 
'■  Tournaments,  dutes  of,  76 
Treatment  of  round  shoulders,  256 

of  scoliosis,  291 

of  uneven  shoulders,  270 
Trenihle-pressing,  dcscripiiim  of,  54 
TulK-nuti)ftis,  exercise  for,  227 
Turnfest  at  Frankfort,  79 
Turngcnieinden  in  America,  82 
Turning  in  German  Universities,  76 
Turnkunst,  liadgc  of,  76 
Turnplatz,  first,  75 
Turnvereine,  descriptions  of,  79 

University  oars.  Morgan  on,  321 
of  Pennsylvania,  31,  42 
physical  education  at,  176 
I'rbinization  of  jxjjmlation,  132 

Valvular  defects  of  heart,  315 
\'an  de  Walker  on  the  blind,  199 
Vibration.  53 

application  of,  71 

for  rheumalUm.  358 

for  sciatica,  371 

Pilgrim  on,  71-73 

theory  of,  73 


406 


VibraUvt,  Eberhart  on,  71 

mcxlifications  of,  70 

Zander's,  70 
Virchow,  81 

Vun  Lryden's  ttainvay,  385,  j86 
Von  Noorden,  325 

on  massage  in  obesity,  353 
Von  Schenkendorff,  83 

Wadino  pool,  153 
Wallting,  rate  of,  134,  135 
Warnrr  on  mental  defectives,  211 
Washington  Gardens,  gymnasium  at,  82 
Water-polo,  effect  on  blood,  33 
Weber  on  prolongation  of  life,  131 
Weight,  loss  of,  42 

Lombard  on,  43,  43 
of  foot-liall  players,  180 
of  oarsmen,  180 
reduction,  dangers  of,  355 

Stagg  on,  352 
Weir  Mitchell,  31,  55 

on  nervous  dsypepsia,  360 

on  neurasthenia,  376 


Welledey  and  Boston  Normal  School,  93 
Wey  on  criminals,  330 
Wide  on  massage  for  heart  diseaae,  335 
Williams  College,  143 

German  gymnastics  at,  83 
Whitman's  foot-plate  for  flat-foot,  347 
Witmer  on  pain  organ,  73,  370 
Writing  position,  160 

Gould's,  293 

Vale   University,   Gernum  gymnastics 

at,  83 
Voshin-Riu,  104 

Zavdek,  17,  54 

history  of,  66 

institutes,  66 

machines,  66-70 
advantages  of,  70 

on  constipation,  363 

on  reducing  pulse-rate,  335 
Zander's  tower,  234 

for  round  shoulders,  363 

vibrator,  70 


